Injection Practices Research Articles

Insulin Injection Technique and Related Complications in Patients With Diabetes in a Northwest City of China.

Appropriate insulin injection technique can help to enhance positive clinical outcomes in insulin-treated patients. This cross-sectional survey was undertaken to assess the present state of injection technique practices of patients administering insulin and the incidence of local complications associated with insulin injection. This cross-sectional study was conducted at 11 tertiary hospitals in Xi'an City. A total of 1370 patients with diabetes were enroled in the survey. Each patient was asked questions on the Injection Technique questionnaire, demonstrated insulin injection on an injection training pad and had their injection sites inspected by a nurse. About 98% of participants were type 2 diabetic patients. The 5 mm length needles were used by 640 (46.71%) patients. Around 1286 participants reused pen needles. Only one-third of patients rotate the injection sites. Around 901 patients had ecchymosis at injection sites, 43 participants suffered rash and or pruritus and 661 patients had lipohypertrophy. About 2.99% of patients reported having infection at the injection sites. Most patients (72.55%) occasionally felt pain when injecting insulin. The results of the multivariable logistict analysis showed that gender (male), needle length, priming the pen before injections and correct site rotation were negatively associated with the incidence of injection site ecchymosis. Lower incidence of lipohypertrophy was associated with needle length 4 mm, needle length 6 mm, single use of pen needles, priming the pen before injections and correct site rotation. Higher incidence of injection site infection was related to not disinfecting injection sites before each injection. Despite some improvements detected in some aspects of patients' insulin injection practice in recent years, a large gap still exists between insulin injection guidelines and patients' actual injection behaviour. Injection-related complications at injection sites are still considerably common among our study population. Patients' education regarding insulin injection technique should be conducted repeatedly and regularly to make sure patients' compliance to injection guidelines.

Effectiveness of health education on insulin injection technique in patients with type 2 diabetes mellitus: A quasi-experimental Pre-test post-test research

ABSTRACT Introduction: Type 2 Diabetes Mellitus (T2DM) patients often exhibit gaps in knowledge and improper practices regarding insulin injection techniques. This quasi-experimental study aimed to assess the effectiveness of tailored health education in bridging these gaps and improving insulin injection practices among T2DM patients. Objectives: The study aimed to evaluate baseline knowledge and practices related to insulin injection techniques among T2DM patients, implement a tailored health education intervention, and assess the impact of this intervention on knowledge and practices. Methodology: Participants included T2DM patients attending rural health centers. A structured questionnaire was utilized to assess baseline knowledge and practices. Tailored health education sessions were then conducted, incorporating video-based teaching, mock demonstrations, and handouts in the local language. Post-intervention assessments were performed using the same questionnaire. Data were analyzed using appropriate statistical methods. Results: At baseline, a significant knowledge gap and improper insulin injection practices were identified among participants. Following the tailored health education intervention, a substantial improvement in participants’ knowledge of insulin storage, handling, and administration was observed. The intervention also positively impacted insulin injection practices, emphasizing key areas such as handwashing, site cleansing, and needle disposal. Conclusion: This quasi-experimental study highlights the effectiveness of tailored health education in enhancing insulin injection practices among T2DM patients. The findings emphasize the potential for structured health education programs to address knowledge gaps, improve healthcare standards, and enhance the overall quality of life for individuals with T2DM. The study underscores the importance of individualized educational approaches to meet patient needs better.

Latent factors affecting safer injection practices that can reduce infections and how education can improve them.

The incidence of healthcare-associated infections, particularly injection-related infections, can increase patient comorbidities even in countries with adequate medical resources. Although there are clear guidelines for injection practices to prevent infections, their application in clinical settings is insufficient. Therefore, the objective of this study was to identify factors affecting injection practices associated with reduced infections by conducting surveys targeting practicing healthcare providers involved in administering injections at each healthcare organization and performing data analysis. We administered a survey to healthcare providers responsible for injection practices at each healthcare organization that included items related to infection-safe injection practice guidelines. All survey questions were reviewed by an expert panel of infectious disease and infection control nurses. Survey contents were subjected to exploratory factor analysis (EFA), confirmatory factor analysis, and multivariable robust regression tests to determine the impact of each factor and their correlations. A total of 842 questionnaires were analyzed. Each questionnaire was classified into four factors: reuse and contamination, compliance with aseptic technique, exchange of infusion set, and use of multidose vials. Nurses with higher careers showed more compliance. Education within one year and awareness of each item of the questionnaire had positive associations with proper injection practice. Education is thought to be the most important factor in good injection practices that could reduce infections. Relevant knowledge through timely training is expected to have a positive impact on performance and compliance related to safe injections.

Transportation, storage and injection practices of insulin among patients with diabetes mellitus attending a medical clinic at a tertiary care centre in Sri Lanka

Background: Failure to maintain the cold chain during the transportation and storage of insulin and incorrect techniques of insulin injection lead to fluctuations of glycaemic control and complications among patients with diabetes mellitus. Objective: The study assessed transportation, storage, and injection practices of insulin among diabetic patients. Methods: A descriptive cross-sectional study was conducted among 200 consecutive diabetic patients on regular insulin attending a follow-up medical clinic at National Hospital, Colombo. An interviewer-administered questionnaire was used to collect data on patients’ socio-demographic factors, insulin transportation methods, storage, and injection practices. Results: All the study participants (age 59 SD±11.5; males 44.5%; females 55.5%) were on premixed insulin while 15% (n=30) used additional soluble insulin. The majority (56%) failed to maintain the cold chain during transportation while 1.5% (n=3) stored insulin in the freezer compartment. Only 33.5% (n=67) had glucometers at home to monitor their glucose levels and 27% failed to comply with the recommended dosage. Only 52.5% (n=105) adhered to the correct timing recommended. The majority (95.5%; n=191) practiced rotation of the injection site and 32% (n=64) rolled the vial between palms before injection. A minority (24.5%) failed to clean the injection site while 63.5% (n=127) practiced pinching of the skin fold before injection. All 6 steps of insulin injection were correctly practiced by 6.5% (n=13) denoting significant lapses in their knowledge and technique. Conclusion: A significant number of insulin users follow incorrect transportation and injection practices. Interventions are required to improve them

Doses of Botulinum Toxin in Cervical Dystonia: Does Ultrasound Guidance Change Injection Practices?

Cervical dystonia is widely understood to benefit from botulinum toxin injections. The injection practices may be influenced by specific factors, including the method of injection. Three main guidance methods can be used: palpation of anatomical landmarks, ultrasound, and electromyography. We investigated how target muscles and doses of botulinum toxin were modified after the transition from surface anatomy (non-guided) to ultrasound (US-guided), in patients with cervical dystonia. We also determined the long-term dose trend. We studied a group of 82 patients, who received non-guided injections (median: 16.5 cycles/5.1 years) followed by US-guided injections (median: 12.0 cycles/3.8 years). More muscles, and especially deep muscles, were injected during the US-guided period. The total dose and number of injected muscles were higher when US guidance was used, but the mean dose per muscle was lower. Over the long term, the total dose stabilized, and the mean dose per muscle decreased during the US-guided period. According to our results, the guidance method has a strong impact on the botulinum toxin injection strategy in cervical dystonia (target muscles and dose). Also, the treatment appeared more stable when using US guidance; this could be explained by the good precision of such injections.

Multimodal Pilot Evaluation of a Hyaluronic Acid Infraorbital Filler Using Precise, Multi-Positional, 3D Imaging Quantification, Patient Reported Outcomes, and Anatomic Cadaveric Assessments

Abstract Background Despite the high demand of filler in the infraorbital area, there remains debate on injection practices, precise anatomical placement, and hyaluronic acid (HA) filler behavior. Objectives We aimed to contribute to the clinical and anatomic understanding of infraorbital HA injection via a prospective patient injection study in combination with a cadaveric analysis. Methods Patients were injected with Volbella XC into the tear trough region by a single experienced aesthetic plastic surgeon. Over a 90-day period, precise undereye volumetric measurements using 3D photogrammetry (VECTRA-M3) and patient reported outcomes (FACE-Q) were collected and analyzed relative to two pretreatment severity scales. Juvéderm Vycross and Restylane NASHA products were injected into the infraorbital and malar region in six cephalus specimens and evaluated with regards to the anatomic injection location with and without common clinical physical manipulations. Results Eleven patients participated with a 100% retention rate. Infraorbital HA volume maintenance was 70-81% at 30 days and 50-70% at 90 days. Significant improvement was noted in the eyes, overall facial appearance, and cheekbones (p<0.05) with FACE-Q outcomes, irrespective of pretreatment severity. In the cadaver examination, we observed differences in the anatomic locations occupied by Juvéderm and Restylane products as well as in behavior after physical manipulation between gel types. Conclusions Volbella XC effectively augments undereye volume to diminish infraorbital hollowing as measured over a 90-day period with significantly improved PROs. Enhanced knowledge of the behavior of Volbella XC and other HA fillers in this sensitive anatomic region will lead to improved patient outcomes.

12606 Gamification In The Management Of Children And Adolescents With Diabetes: A Systematic Review

Abstract Disclosure: L.C. Hespanhol: None. V. Lins de Menezes: None. P. Souto Maia: None. C.A. Balieiro: None. W. Oliveira Amador: None. R. Lira: None. Background: Educating children and adolescents with diabetes about their own condition presents a significant challenge. Gamification has been proposed as an innovative approach to ease the transition to self-care by engaging and empowering children and adolescents in their diabetes management. Purpose: The purpose of this systematic review is to examine published research on using gamification and technology within diabetes care for young patients. Methods: PubMed, Lilacs and EMBASE were systematically searched in January 2024 to include articles focusing on the use of new virtual technologies to improve the clinical and laboratory conditions of children and adolescents with diabetes. The protocol was registered in PROSPERO (ID: CRD42024499381) adhering to PRISMA recommendations. We assessed the risk of bias using RoB-2 and ROBINS-I. Results: A total of 24 studies were included, of which 7 were randomized trials. Age of participants ranged from 5 to 19 years. We identified five gamification strategies (i.e., applications, video games, minigame, robot, or web game) within seven clinical domains (i.e., psychosocial impairment, glycemic control, autonomy, reduced frequency of error, health lifestyle, nutrition, or knowledge about disease). 246 (27%) patients demonstrated reduced emotional distress and increased enjoyment. Reduction of errors such as hypoglycemia and emergency preparedness was identified in 354 (39%) of patients and improvement in glycemic control measured by HbA1c was described in 277 (30%) of patients. Conclusion: Our systematic review gamification has shown promise in fostering autonomy by providing tools that educate young individuals regarding glycemic control, lifestyle choices, injection practices, carbohydrate counting, and other pertinent aspects of diabetes management. Presentation: 6/1/2024

Real-World Use of Intradetrusor Botulinum Toxin Injections: A Population-Based Study from France.

In recent decades, intradetrusor injections of botulinum toxin A (BoNT-A) have been widely applied to treat incontinence in both idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity incontinence (NDOI). This analysis, based on the French National Hospital Discharge Database (PMSI), aims to describe real-world trends in intradetrusor BoNT-A use between 2014 and 2022. Among 32,864 patients who received at least one intradetrusor BoNT-A injection, 18,320 (55.7%) had conditions coded under iOAB, 13,376 (40.7%) under NDOI, and 1168 (3.6%) under other indications. The overall mean interval between two intradetrusor BoNT-A injections was 9.7 months, ranging from 8.7 months in patients with multiple sclerosis (MS) to 11.5 months in patients with cerebral pathologies. The median number of injections was two (quartile 1-quartile 3, 1-4) in patients with spina bifida, whereas it was five (2-10) in those with MS. Only 31% of patients with iOAB received more than two intradetrusor BoNT-A injections. Regardless of its indication, BoNT-A was well tolerated. Adverse events occurring during or requiring hospitalization included infections (3.8%), hematuria (0.53%), and bleeding episodes necessitating transfusions (0.11%), all recorded within the initial month following BoNT-A injection. Our analysis of the PMSI database highlights a broad spectrum of intradetrusor BoNT-A injection practices.

Protective Factors Associated With Lower Likelihood of Injection Drug Use and Experiencing Overdose Among Incarcerated Women

PurposePrior studies evaluated protective factors individually as they relate to fewer drug use risk behaviors and related consequences. This is the first study to examine protective factors as part of a multilevel framework along a risk continuum among women involved in the criminal legal system who use drugs. This study describes factors within the socio-ecological framework that are protective against engaging in injection drug use and experiencing nonfatal overdose. MethodData were collected from 900 women with a history of opioid use disorder who were incarcerated and enrolled in the National Institutes of Health/National Institute on Drug Abuse–funded Justice Community Opioid Innovation Network cooperative. Analysis focused on the relationship among individual, interpersonal, and community- or institutional-level protective factors associated with not injecting drugs and not experiencing an overdose in the 90 days before incarceration using multinomial logistic regression. FindingsFindings from this study suggest that, even among a sample of women who use drugs, there are a number of factors associated with being less likely to report higher-risk injection behavior and/or overdose experiences at the individual level (age, religiosity, and less polysubstance use), interpersonal level (not having a partner who injects drugs), and community or institutional level (fewer months incarcerated, less treatment utilization, and less enacted stigma by health care workers). ConclusionsFindings from this study underscore the importance of being able to target prevention interventions to women at different stages of substance use severity and to capitalize on protective factors for those at lower-risk levels to reduce the trajectory of risk to injection practices and overdose experiences.

Assessing Potential Seismic Hazard in Enhanced Geothermal Systems: Insights from Comparing Gonghe and Pohang Reservoirs

Abstract Evaluating and predicting the seismic hazard induced by fluid injection in enhanced geothermal systems (EGSs) is critical for safe and effective operations. This study compares the Gonghe project, a pioneering EGS initiative in China, with the well-studied Pohang EGS in South Korea, within a broader context of global fluid injection practices. We assessed the potential seismic hazard at these two sites based on their seismogenic indices (Σ). We find that Σ of the Gonghe EGS generally decreases from 0.4 to −0.7, consistent with the typical ranges of Σ in EGS sites, including Pohang. Our results indicate that real-time Σ is a more reliable measure for assessing seismic hazard in Gonghe because it offers insights into the maximum magnitude, exceedance probabilities, and expected numbers of earthquakes. Conversely, in Pohang, maximum Σ proves more effective for seismic hazard assessment. However, predicting the seismic hazard after the Mw 3.2 earthquake in Pohang remains challenging, particularly for the runaway rupture associated with the subsequent Mw 5.5 earthquake, highlighting the complexities involved. This study suggests that the use of real-time Σ is viable for assessing seismic hazard in EGS reservoirs characterized by descending Σ and seismic injection efficiency. Conversely, for reservoirs with ascending Σ and seismic injection efficiency, such as Pohang, maximum Σ could offer better insights into seismic hazard assessment, although precise earthquake magnitude constraints may be elusive due to dominant tectonic influences.

HIV and hepatitis C virus infection and co-infection among trans women in San Francisco, 2020.

Transgender women (hereafter "trans women") face social marginalization, stigma, and discrimination and experience a high burden of HIV. More recently, trans women have been identified as having a high risk for hepatitis C (HCV) infection. The interaction between these two diseases and the risks for HIV/HCV co-infection among trans women are understudied. To characterize epidemiological, behavioral, and socio-structural interactions between HIV and HCV infections among trans women. This cross-sectional study examined data from a community-based survey of trans women in San Francisco recruited through respondent-driven sampling (RDS) in 2019/2020. Face-to-face interviews collected data on demographics, medical history, drug injection practices, sexual behavior, and socio-structural factors (e.g., poverty, housing insecurity, incarceration, social support). HIV and HCV antibodies were detected using oral fluid rapid tests and prior diagnosis and treatment were collected by self-report. Blood specimens were collected to confirm antibodies using ELISA. Multinomial logistic regression analysis characterized factors associated with HIV infection alone, HCV infection alone, and HIV/HCV co-infection compared to neither infection. Among 201 trans women recruited, HIV prevalence was 42.3%; HCV infection by history or current seroprevalence was 28.9%; evidence for both HIV and HCV infection was present for 18.9%. Two-thirds of trans women (67.2%) had been incarcerated; 30.8% had ever injected drugs. History of injection drug use and receiving emotional support from family were factors found in common for HIV infection, HCV infection, and HIV/HCV co-infection compared to no infection. Having a sexual partner who injects drugs was associated with HIV infection alone. Not lacking care due to cost and older age were associated with co-infection. Older age was also associated with HCV infection. Of trans women with HIV infection, 91.8% had accessed HIV care, whereas only 62% with HCV had accessed some form of care. Our study found high levels of HIV, HCV, and HIV/HCV co-infection among trans women in San Francisco. We found common associations between HIV and HCV through injection practices and emotional support, but having a sexual partner who injects drugs was not associated with HCV infection alone or co-infection. We note a substantial gap in the treatment of HCV for trans women, including those in HIV care, that needs to be urgently addressed.

Intravitreal injection practice patterns among Chinese ophthalmologists.

To describe the practice patterns of intravitreal injections (IVIs) among ophthalmologists in China. This was a cross-sectional online survey. Ophthalmologists who had performed accumulated more than 100 injections were contacted by the Brightness Center, a hospital-based national network, to complete an anonymous, 24-question, internet-based survey. They were surveyed on practices in injection techniques, pre-, and post-injections procedures. A total of 333 ophthalmologists from 28 provinces/municipalities/autonomous regions responded to the survey (50.68% response rate). The 91.29% of the respondents evaluated systemic risk factors by medical history, electrocardiogram (ECG) and blood test. All the respondents used pre-injection prophylactic antibiotics. Most checked intraocular pressure (IOP, 99.1%) and blood pressure (96.1%) before injections. A majority of the respondents performed injections in the operating room (98.8%), wore masks (99.7%), gloves (99.4%) and sterile surgical clothing (96.1%), performed topical anesthetics (97.9%), and applied povidone-iodine (95.8%) pre-injection. The 61.26% of the respondents dilated pupil. About half of the respondents (51.05%) performed bilateral injections in the same setting. Superior temporal quadrant (40.54%) was the most frequent site of injection. Around three quarters used 30-gauge needles. Most respondents (97.9%) measured the site of injection from limbus. More than half (53.45%) performed conjunctiva displacement prior to injection. The 32.43% of the respondents checked IOP post-injection and 87.99% physicians checked hand motion (HM) or counting fingers (CF) after injection, while 36.94% observed optic nerve perfusion. All participants used topical antibiotics post-injections. Most physicians (91.89%) reviewed patients on the following day. This study provides a description of the real-world practice patterns in IVIs in China and offers critical information regarding education and training of ophthalmologists and amendment of local society guidelines.

Self-Reported Illicitly Manufactured Fentanyl Use and Associated Health and Substance Use Risks in the United States, 2022

Objective Illicitly manufactured fentanyl (IMF) has emerged as a catalyst of the recent drug epidemic in the United States. To devise more targeted and effective prevention and treatment strategies, it is crucial to understand the demographics of the population who consumes IMF and their health and associated substance use risks. Therefore, this study explores the sociodemographic characteristics, health diagnoses, and drug injection practices of individuals reporting IMF use. Methods Data were derived from the 2022 National Survey on Drug Use Health, based on a nationally representative sample of non-institutionalized individuals aged 12 and older in the United States. Focusing on 306 adults who reported ever using IMF, we examined their sociodemographic characteristics, health diagnoses, and substance-related behaviors in comparison to adults with a drug use disorder who did not report IMF use, using logistic regression analyses. Results The majority of U.S. adults reporting IMF use were aged 35–64, male, non-Hispanic White, with a high school education or lower, never married, and had an annual household income below $40,000. Compared to adults with a drug use disorder who did not report IMF use, they were more likely to report heart conditions (AOR = 2.67, 95% CI = 1.29–5.54) and Hepatitis B or C (AOR = 8.35, 95% CI = 4.05–17.02). Nearly half of this group had an opioid use disorder (OUD) in the past year, and 65.7% (95% CI = 56.7–74.8) reported a history of injecting drugs. Conclusions To effectively curb the current drug epidemic, incorporating effective treatment for OUD and harm reduction strategies is crucial.

Artificial Intelligence Technology on Layered Water Injection in Oilfield Development Process

Since the 1960s, researchers have worked to advance water flooding technology to address challenges like high viscosity, low fluidity, and depleting reservoirs, aiming to prevent oil fields from becoming unproductive. The integration of artificial intelligence (AI), computer vision, and advanced algorithms like BP neural networks has recently revolutionized this field. These technological advancements have upgraded water injection methodologies, overcoming past limitations and enabling real-time monitoring and dynamic control of water injection into different oil layers. This 'intelligent layering' ensures optimized water management, enhancing overall recovery rates. This overview highlights the progression of water injection techniques, critiques traditional methods' shortcomings, and delves into the cutting-edge applications of AI-driven intelligent layering systems. It serves as a valuable guide for oil industry stakeholders, equipment manufacturers, and research institutions seeking to refine water injection practices and boost hydrocarbon extraction efficiency.

Treatment of Acquired Deforming Hypertonia with Botulinum Toxin in Older Population: A Retrospective Study.

Acquired deforming hypertonia (ADH) affects the daily care of numerous nursing home residents. The aim of this study was to analyze the practice, aims, and effectiveness of botulinum toxin injections (BTxis) in the treatment of older patients with contractures, an indication for which BTxis are still underused. Data were extracted retrospectively from medical records regarding population, contractures, and injections. A prospective analysis was conducted to evaluate treatment goals set by goal attainment scaling (GAS) at T0 and at T1, to evaluate the therapeutic effects. We also recorded the occurrence of side effects, using a telephone questionnaire. This study included 41 patients older than 70 years who had received one or more BTxis for the first time between January 2018 and December 2021. Most of the older people we included lived in an institution (66%), manifested severe dependence, and presented significant morbi-mortality (37% of the patients died in the year after the last injection). The main objectives of these injections were purely comfort, without any functional goals. The GAS scores suggested effectiveness for comfort GAS scores. No complications were recorded. This study highlights the BTxis potential to address the needs of a larger number of older patients with ADH.

Drug use practices and wound care experiences in the age of xylazine adulteration

Exposure to xylazine has been associated with wounds distinct from typical injection-related skin and soft tissue infections. We sought to understand drug use and wound care practices, and treatment experiences of people who use drugs (PWUD) in a high-prevalence area of xylazine adulteration. In August 2023, we surveyed adult PWUD reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs. Using a representative illustration, participants indicated if they had experienced a xylazine wound in the past 90 days. We compared demographic, drug use factors, wound care, and medical treatment experiences among those with and without xylazine wounds. We also conducted additional content analysis of open-ended responses. Of the 171 respondents, 87 % (n=148) had a xylazine wound in the past 90 days. There were no statistically significant demographic differences between those with and without xylazine wounds. Among those primarily injecting (n=155), subcutaneous injection was nearly ten times more likely among people with xylazine wounds. For those with xylazine wounds (n=148), many engaged in heterogeneous wound self-treatment practices, and when seeking medical care, 74 % experienced healthcare stigma and 58 % had inadequate pain and withdrawal management. People with self-identified xylazine wounds were more likely to engage in subcutaneous injection and faced several barriers seeking medical wound treatment. Programs serving people exposed to xylazine should work to support safer injection practices, including alternatives to injecting and improving access to high-quality, effective wound care. Further study is warranted to understand the causes, promoters, and prevention of xylazine-related wounds.

Development of a Patient and Clinician Informed Website on Injection Drug Use Related Infective Endocarditis.

Few patient-facing educational materials and interventions exist for the prevention of injection drug use-related infective endocarditis (IDU-IE). We developed a patient and clinician-informed website for patients about IDU-IE to promote education and prevention strategies. This mixed-methods study integrated surveys and semi-structured interviews with patients and clinician to develop a patient website about IDU-IE. Patient participants included hospitalized adults with an opioid use disorder, history of injection drug use, and an injection drug use-related infection. Interprofessional healthcare clinicians including trainees participated. A baseline survey and semi-structured interviews were conducted with patients to understand knowledge of IDU-IE and preferences in educational materials content and format. Interviews were analyzed using rapid qualitative analysis. Results informed development of the patient website. Finally, patients and clinicians provided 2 rounds of survey feedback after reviewing the website, assessing the likelihood of using and recommending it to others, helpfulness of information in the website sections, and content satisfaction. Patient participants (n = 15) reported low baseline understanding of injection practice and risk of IDU-IE. After reviewing the website (n = 17), patients reported they were very likely to recommend the website as a reference for themselves (mean of 4.3; 4 = very likely) and for others (mean = 4.3). They found the following sections, on average, to be very helpful (4 = very helpful): complications from injection drug use (4.4), safer injection practice (4.4), and information about infective endocarditis (4.4). Patients on average were satisfied with the website content overall (4.8). Clinicians (n = 27) reported, on average, being very likely to recommend this website to a patient (4.4) and to use the website to counsel patients (4.1). A patient and clinician-informed website on IDU-IE is acceptable for patients and clinicians to use as a patient education resource to help prevent IDU-IE-related harms.

Surgical Management of Iatrogenic Mercury Poisoning From Subcutaneous Injection Into the Arm.

Mercury, an element with threats of severe toxic insult to humans and no biological function, has a surprisingly extensive record of human exposure. Regardless of hesitancies toward its harmfulness, it has been historically identified with an almost supernatural power to provide protection from evil and sickness, give good fortune, lend aid in athletic undertakings, or even allow one to achieve immortality. Mercury poisoning is an iatrogenic disease even today as people attempt to achieve these effects through volitional injections into their body by practitioners. Although an uncommon practice in the United States, awareness of patient presentation after volitional injections of elemental mercury is necessary for appropriate treatment of these patients. We aim to increase awareness of the cultural practice of subcutaneous injections of mercury, as it is uncommonly seen in the United States, to contribute a broader understanding to the patient's medical presentation and describe an approach and the impact of medical and surgical intervention. In this report, we describe a rare case of elemental mercury poisoning secondary to volitional subcutaneous injection to the arm. Initial management of care through chelation therapy and monitoring of renal and serum mercury levels in addition to symptoms of systemic spread was overseen by an internal medicine physician and poison control. Surgical intervention via full-thickness excision of the visible mercury to the right arm followed by local flap and skin grafting reconstruction was performed. Mercury poisoning from intentional subcutaneous administration is an uncommon patient presentation in the United States; however, knowledge of management of this rare condition is important for effective management of iatrogenic mercury toxicity.

Prevalence and Modes of Transmission of Hepatitis C Virus Infection: A Historical Worldwide Review.

Hepatitis C virus infection affects over 58 million individuals and is responsible for 290,000 annual deaths. The infection spread in the past via blood transfusion and iatrogenic transmission due to the use of non-sterilized glass syringes mostly in developing countries (Cameroon, Central Africa Republic, Egypt) but even in Italy. High-income countries have achieved successful results in preventing certain modes of transmission, particularly in ensuring the safety of blood and blood products, and to a lesser extent, reducing iatrogenic exposure. Conversely, in low-income countries, unscreened blood transfusions and non-sterile injection practices continue to play major roles, highlighting the stark inequalities between these regions. Currently, injection drug use is a major worldwide risk factor, with a growing trend even in low- and middle-income countries (LMICs). Emerging high-risk groups include men who have sex with men (MSM), individuals exposed to tattoo practices, and newborns of HCV-infected pregnant women. The World Health Organization (WHO) has proposed direct-acting antiviral (DAA) therapy as a tool to eliminate infection by interrupting viral transmission from infected to susceptible individuals. However, the feasibility of this ambitious and overly optimistic program generates concern about the need for universal screening, diagnosis, linkage to care, and access to affordable DAA regimens. These goals are very hard to reach, especially in LMICs, due to the cost and availability of drugs, as well as the logistical complexities involved. Globally, only a small proportion of individuals infected with HCV have been tested, and an even smaller fraction of those have initiated DAA therapy. The absence of an effective vaccine is a major barrier to controlling HCV infection. Without a vaccine, the WHO project may remain merely an illusion.

Changes in risk behaviour following a network peer education intervention for HIV prevention among male Tajik migrants who inject drugs in Moscow: a cluster-randomized controlled trial.

The "Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) recruits and trains Tajik labour migrants who inject drugs as peer educators (PEs) in delivering HIV prevention information and encouragement to adopt risk-reduction norms and practices within their diaspora social networks while reducing their own HIV risk. The MASLIHAT intervention was tested in Moscow in a cluster-randomized controlled trial with 12 recruitment sites assigned to either the MASLIHAT intervention or an equal-time peer-educator training focused on other health conditions (TANSIHAT). From October 2021 to April 2022, 140 male Tajik migrants who inject drugs were recruited as PEs to attend the 5-session MASLIHAT training or the TANSIHAT non-HIV comparison condition. Each participant in both groups recruited two network members (NMs) who inject drugs with the intent to share with them the information and positive strategies for change they had learned (n = 280). All PEs and NMs (n = 420) participated in baseline and follow-up interviews at 3-month intervals for 1 year. All received HIV counselling and testing. Modified mixed effects Poisson regressions tested for group differences in injection practices, sexual risk behaviours and heavy alcohol use over time. At baseline, across both groups, 75% of participants reported receptive syringe sharing (RSS), 42% reported condomless sex and 20% reported binge drinking at least once a month. In contrast to TANSIHAT where HIV risk behaviours remained the same, significant intervention effects that were sustained over the 12 months were observed for receptive syringe and ancillary equipment sharing among both MASLIHAT PEs and NMs (p < 0.0001). Significant declines in the prevalence of sexual risk behaviours were also associated with the MASLIHAT intervention (p < 0.01), but not the comparison condition. Binge alcohol use was not affected in either condition; the MASLIHAT intervention had a transitory effect on drinking frequency that dissipated after 9 months. The MASLIHAT peer-education intervention proved highly effective in reducing HIV-related injection risk behaviour, and moderately effective in reducing sexual risk behaviour among both PEs and NMs. Network-based peer education is an important tool for HIV prevention among people who inject drugs, especially in environments that are not amenable to community-based harm reduction.