Intravenous Drug Research Articles

Randomized controlled trial of a pilot PrEP linkage intervention for individuals leaving incarceration in a southern state: Design and baseline characteristics.

We report baseline characteristics of a pilot intervention, PrEP-Link, which uses a community health worker (CHW) model to provide navigation to PrEP, the daily HIV preventative medication, and other medical and social services upon release from incarceration. This pilot study uses a randomized controlled trial design. The control group receives enhanced standard of care, and the intervention receives enhanced standard of care plus personalized navigation services from the CHW for up to one year. PrEP-Link is modeled after the Transitions Clinic Program, where a CHW who has lived experience of incarceration builds close relationships with individuals and community partners. After COVID-19 restrictions prevented recruitment within local jails, recruitment for this study took place in local reentry centers which house individuals as they near completion of their jail or prison sentence. Data are collected at baseline, 6 months, and 12 months. Planning and reporting was guided by the CONSORT 2010 checklist. We enrolled 80 participants between September 2021 and April 2023. Thirty-nine participants were assigned to the control group and forty-one to the intervention group. Data collected at baseline included measures of PrEP usage, HIV risk, drug and alcohol use, healthcare usage, and history of incarceration. Analysis of baseline characteristics show comparability of both demographic and HIV-related risk factors between the two arms. At baseline, participants had high clinical indication for potential PrEP benefit, particularly with respect to self-reported intravenous drug use and condomless sex. Participants responded with high PrEP acceptability within both study arms. Participants reported low preventative healthcare utilization at baseline. Barriers to accessing PrEP among the study population are significant. Results of this pilot RTC will help inform CHW lead PrEP-linkage interventions for people leaving incarceration.

Applications of a biocompatible alginate/pericardial fluid-based hydrogel for the production of a bioink in tissue engineering.

Enhancing the biocompatibility of biomaterials is a critical aspect of tissue engineering and regenerative medicine. Advances in 3D bioprinting technology, blending natural and synthetic materials for the production of bioink, offer new opportunities to develop highly biocompatible materials that can closely mimic the native tissue environment. In this study, we used pericardial fluid structure (PFS)-based material together with alginate to mimic the extracellular matrix (ECM) and produce a bioink material. Thus, blended alginate with PFS material and MC3T3-E1 pre-osteoblast cell-laden hydrogels characterized by comparing each other, especially alginate hydrogels, and evaluated in terms of biocompatibility for tissue engineering applications. According to the rheological analysis results, all hydrogel groups A, A-PFS (150mg), and A-PFS (1:1) had viscoelastic properties. Mechanical tests showed that the A-PFS (1:1) hydrogel had the most strength properties. Additionally, the viscosity values of the hydrogel solutions were in an applicable range for use in 3D bioprinters. It was also found out that PFS increased the biocompatibility of alginate-based bioink, in terms of cell proliferation and differentiation. Overall, these findings suggest that alginate and pericardial fluid-based materials can be successfully used for bioink production. The resulting hydrogels exhibit viscoelastic properties, appropriate viscosity for 3D bioprinting, and support cell viability, proliferation, and osteogenic differentiation. This research has the potential not only to produce bioink but also to produce injectable hydrogels and drug delivery systems, which can become biocompatible materials that can be used for tissue engineering and regenerative medicine applications.

Drug use patterns and health problems among people who use drugs in Guinea-Bissau (2022): A cross-sectional survey using respondent-driven sampling

BackgroundLittle data exists on the use of cocaine, methamphetamine, tramadol and heroin or related health conditions in Guinea Bissau. We aimed to estimate drug use practices and the prevalence of selected blood-borne infections, depression and population size estimates of people who use injectable drugs in Guinea-Bissau. MethodsWe used respondent-driven sampling to recruit adults who use injectable drugs in this cross sectional survey in three cities (Bissau, Bafatá and Gabú) between July and September 2022. Participants completed an interviewer administered survey enquiring about sociodemographic characteristics, drug use practices and mental health. Rapid diagnostic testing was done for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV). Data was weighted in RDS-Analyst using self-reported network size and Gile's Sequential Sampling Estimator. Population size estimates were generated using the two point capture-recapture method. ResultsOverall, 750 participants were recruited. People who use drugs were estimated to be mostly unemployed males aged between 25 and 49 years. Methamphetamine and crack cocaine were most commonly used. Prevalence of ever injecting ranged from 6 % to 44 %. Between 44 % and 52 % of people experience symptoms of depression. Prevalence ranges from 1.9 % to 5.2 % for HIV, and 5.7–8.3 % for HBsAg and 0.42–0.66 % for anti-HCV. The population estimates of people who use injectable drugs were 1637 in Bissau, 1314 in Bafatá and 424 in Gabú. ConclusionMethamphetamine and crack cocaine are the most commonly used injectable drugs in Guinea-Bissau. Symptoms of depression are common among people who use drugs in the country. Access to evidence-based drug use treatment and harm reduction interventions that integrate mental health care services are needed to improve the health and wellbeing of people who use drugs in Guinea-Bissau.

Matter of the heart: Prioritizing harm reduction in managing infective endocarditis associated with injection drug use.

Matter of the heart: Prioritizing harm reduction in managing infective endocarditis associated with injection drug use.

Applying population-specific incidence prevalence ratio benchmarks to monitor the Australian HIV epidemic: an epidemiological analysis.

Due to a lack of robust population denominators, Australia is unable to accurately monitor changes in the HIV epidemic for some populations. The ratio of HIV transmission relative to the number of people with HIV (an incidence prevalence ratio, or IPR) can measure such changes. The IPR is measured against an IPR benchmark derived from post-HIV acquisition life expectancy, to indicate whether an HIV epidemic is shrinking or growing. Using IPRs and Australia-specific IPR benchmarks, this study aims to describe the Australian HIV epidemic among three groups: men with HIV attributed to male-to-male sex, women with HIV and people with HIV attributed to injection drug use. Using mathematical modelling derived from HIV notifications, cohort and administrative data, IPRs were generated for each of the three groups. These IPRs were compared with IPR benchmarks derived from post-HIV acquisition mortality estimates using abridged life tables for men, women and people who inject drugs. The IPR benchmark for men was applied to people with HIV attributed to male-to-male sex. Trends in the IPR over time were described for each reported population from 2015 to 2022. Overall, the IPR fell by 80%, from 0.040 (range: 0.034-0.045) in 2015 to 0.008 (range: 0.003-0.013) in 2022 and fell below the benchmark (0.022) in 2020. Among people with HIV attributed to male-to-male sex, the IPR fell by 85%, from 0.041 (range: 0.034-0.047) in 2015 to 0.006 (range: 0.003-0.024) in 2022 and fell below the benchmark (0.022) in 2020. Among women with HIV, the IPR fell by 56%, from 0.032 (range: 0.026-0.039) in 2015 to 0.014 (range: 0.003-0.029) in 2022 and fell below the benchmark (0.022) in 2019. Among people with HIV attributed to injection drug use, the IPR fell by 61%, from 0.036 (range: 0.022-0.047) in 2015 to 0.014 (range: 0.002-0.057) in 2022 and fell below the benchmark (0.028) in 2019. Australian IPRs in all populations examined have dropped below the level required to sustain the HIV epidemic at current levels. By applying this method in other contexts, the changing scale of HIV epidemics may be better described for populations lacking robust population denominators.

The genotoxicity effects and oxidative stress of common volatile and injectable anesthesia drugs on peripheral blood during irradiation of BALB/c mice

IntroductionIonizing radiation (IR) is well-known for its genotoxic and cytotoxic effects. Additionally, anesthesia has been shown to cause various side effects, including genotoxicity. This study aims to evaluate the DNA damage and oxidative stress resulting from exposure to both anesthesia and IR. MethodsSeventy BALB/c male mice were divided into 14 identical groups and anesthetized using three different inhalation anesthetics (isoflurane, sevoflurane, and halothane) and three different injectable anesthetics (propofol, ketamine, and thiopental). We also evaluated combinations of these anesthetic drugs with 1 Gy IR. DNA damage in white blood cells was assessed using the alkaline comet assay at 0, 2, and 24 h after treatment. Additionally, oxidative stress in blood samples was measured 6 h post-treatment. ResultsThe percentage of DNA in the tail and fragmented nuclei after 2 and 24 h was significantly higher in the groups given volatile anesthetics compared to the propofol and thiopental groups (P<0.05). Furthermore, oxidative stress levels were also significantly higher in the volatile anesthetic groups (P<0.05). When combined with IR, the volatile anesthetics and ketamine resulted in increased genotoxicity and significantly higher oxidative stress compared to the group exposed only to IR (P<0.05). In contrast, propofol and thiopental did not lead to a significant increase in genotoxicity or oxidative stress compared to the control group (P>0.07). ConclusionCombining volatile anesthetic drugs and ketamine with 1 Gy irradiation resulted in higher levels of toxic effects and oxidative stress, although this combination did not produce a synergistic effect. Additionally, the combination of propofol and thiopental with IR did not show a significant difference compared to the irradiated-only group in both the alkaline comet and oxidative stress assays.

The diagnosis and treatment progress of infectious endophthalmitis.

Endophthalmitis is a blinding disease that may lead to permanent vision loss. The diagnosis of endophthalmitis relies on clinical findings. It is crucial to identify causative microorganisms in time for subsequent treatment and saving vision. For a long time, cultures of vitreous and/or aqueous humours have been the gold standard for the diagnosis of endophthalmitis. The development of modern molecular diagnostic techniques has brought new opportunities for identifying pathogens rapidly and improving sensitivity. Intravitreal antibiotic injection has the become standard treatment option for infectious endophthalmitis in clinical practice, however, the role and timing of pars plana vitrectomy remains controversial. Moreover, the development of new drugs for intravitreal injection and posterior segment drug delivery systems is expected to achieve the transition from invasive to non-invasive management. Thus, endophthalmitis is an ophthalmic emergency and timely diagnosis and treatment are crucial for preserving vision.

Infective endocarditis in injection drug users: disease course, diagnostic and clinical aspects (clinical case analysis)

Aim. To present and clinically analyze a case of “injection drug users” infective endocarditis (IE) to increase awareness among general practitioners and cardiologists about this special variant of IE.Materials and methods. Clinical observation of a 39-year-old female patient with long-term heroin and methadone addiction, viral hepatitis C, who was diagnosed with acute primary IE caused by methicillin-sensitive Staphylococcus aureus localized on the tricuspid and mitral valves. Bilateral septic pulmonary embolism and respiratory failure, secondary anemia, thrombocytopenia, nephrotic syndrome due to secondary glomerulonephritis were observed. On the 21st day of treatment, the patient underwent tricuspid valve replacement surgery with a biological prosthesis and multicomponent reconstruction of the mitral valve, the postoperative period was complicated by the development of exudative pericarditis.Results. The clinical picture and the course of a complex case of “injection drug users” IE are discussed. The difficulties of early diagnostics of IE caused by the absence of pathognomonic clinical manifestations of the disease and the variability of the debuts of IE with the prevalence of extracardiac manifestations is highlighted. The principles of antibacterial therapy and indications for surgical treatment are reviewed.Conclusion. Clinical observation draws the attention to the high probability of diagnosing IE in cases of fever in intravenous drug users and demonstrates both the difficulties of treatment and the possibility of a favorable outcome of this serious disease with timely diagnosis, appropriate antibacterial therapy, and early cardiac surgery.

Caring for Patients With Injection Drug Use-Associated Infective Endocarditis at the End of Life: A Modified Photo-Elicitation Phenomenological Study.

Admissions for patients with injection drug use-associated infective endocarditis are increasing. Injection drug use-associated infective endocarditis is a serious and often fatal cardiac infection. Nurses are often frustrated when caring for these patients because these care assignments are physically and emotionally demanding. Nurses feel helpless, as they disposition young patients to a funeral homes, morgue, or hospice, or send them home to die, and yet a dearth of information regarding end-of-life care for injection drug use-associated infective endocarditis patients remains. This study explored the lived experiential impact these experiences have on nurses. The method was interpretive and participatory, a modified photo-elicitation phenomenological design. Twenty-nine nurses recruited by purposive sampling took photographs and wrote reflections, with 5 participating in an optional unstructured interview conducted by the author. Three themes emerged from the data that elucidated these experiences as (1) a "heartbreaking" experience to witness, (2) an "exhausting" experience to endure, and (3) a practice-altering experience that transforms. Data analysis reveals that nurses experience intense pain, exhaustion, and, yet, transformation, both negative and positive. Implications for nurses include the need for end-of-life education, formal debriefing process to mitigate turnover, and future research into nature-based therapies to help nurses process trauma, as a form of self-care.

Progress Toward UNAIDS Global HIV Pre-Exposure Prophylaxis Targets: CDC-Supported Oral Pre-Exposure Prophylaxis - 37 Countries, 2017─2023.

Oral pre-exposure prophylaxis (PrEP) reduces HIV acquisition risk from sex by 99% and from injection drug use by ≥74% when used as recommended. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 21.2 million persons using (initiating or continuing) PrEP globally in 2025. In 2016, CDC, with the U.S. President's Emergency Plan for AIDS Relief, joined ministries of health to implement PrEP globally. PrEP is beneficial for persons at substantial risk for acquiring HIV, including but not limited to key populations, which include female sex workers, men who have sex with men, persons in prisons and other enclosed settings, persons who inject drugs, and transgender persons. Annual country targets were used to guide scale-up. In 2023, CDC supported 856,816 PrEP initiations, which represents nearly one quarter of the 3.5 million persons globally who either initiated or continued PrEP that year. During 2017-2023, CDC supported PrEP initiations for 2,278,743 persons, 96.0% of whom were in sub-Saharan Africa. More than one half (64.0%) were female and 44.9% were aged 15-24 years. Overall, CDC achieved 118.7% of its PrEP initiation targets for the 7-year period. Among PrEP initiations for key populations, the majority in sub-Saharan Africa were female sex workers, whereas in Southeast Asia, Eurasia, and the Americas, the majority were men who have sex with men. Continued rapid scale-up is needed to meet the UNAIDS goal to end HIV as a public health threat.

The Impact of Standardization of Intravenous Medication on Patient Safety and Quality of Healthcare: A Systematic Review

Background Intravenous (IV) drugs are essential in today's healthcare systems for providing patients with accurate and timely therapy in a variety of clinical situations. However, administering IV drugs is intrinsically difficult and fraught with error-proneness, which may seriously compromise patient safety and the standard of medical treatment. One important tactic to reduce these hazards and improve overall patient care is the adoption of standardized procedures for IV drug delivery. This systematic literature review aims to thoroughly investigate and summarize the body of knowledge about the effects of IV drug standardization on patient safety and the caliber of healthcare delivery. Methods We used a systematic review approach to examine the impact of standardized intravenous medicine on patient safety and healthcare quality. Guided by the PRISMA framework, we searched articles specifically discussing the standardization of intravenous medication and its implications on patient safety and healthcare quality and related peer-reviewed articles in two major academic databases, PubMed and Google Scholar, based on predetermined eligibility criteria. JBI tool was employed to evaluate the quality of the included studies. Results A total of 112 studies were selected from the two major databases, PubMed and Google Scholar, 61 and 51 studies, respectively. After applying the eligibility criteria, 8 studies were finalized for the systematic review. The outcomes showed a variety of clinical settings demonstrate the importance of standardization, and they argue for the maintenance of a focus on the use of standardized procedures in healthcare settings. Conclusion The study findings provide compelling evidence in favor of the implementation and ongoing focus on standardized medication concentrations as a critical tactic to enhance patient safety and improve the standard of healthcare. Thus, the creation and use of standardized procedures should be given top priority by healthcare institutions as they advance because they will remain essential to the pursuit of healthcare excellence.

Lubricating and Dual-Responsive Injectable Hydrogels Formulated From ZIF-8 Facilitate Osteoarthritis Treatment by Remodeling the Microenvironment.

Osteoarthritis (OA) is a progressively developing condition primarily characterized by the deterioration of articular cartilage and the proliferation of bone, along with ongoing inflammation. Although the precise pathogenesis remains somewhat elusive, restoring the homeostatic balance of the intra-articular microenvironment is crucial for the management of OA. Intra-articular injection of medication is one of the most direct and effective treatment methods; however, most injectable drugs used for osteoarthritis treatment, due to their rapid breakdown, quick release, poor biological activity, and frequent injections, leading to increased risk of infection and suboptimal therapeutic outcomes. In this study, a lubricating and dual-responsive injectable hydrogel based on zeolitic imidazolate frameworks-8 (ZIF-8) impregnated with Quercetin (Que) is designed, which can facilitate OA treatment by remodeling the microenvironment. The prepared injectable nanocomposite hydrogel (MH/CCM@ZIF-8@Que) exhibits pH and reactive oxygen species (ROS) responsiveness, alongside a controllable release of bioactive substances to modulate the microenvironment of bone tissue, thereby mitigating synovitis and the degeneration of cartilage matrix, while simultaneously facilitating cartilage repair. This developed thermosensitive injectable hydrogel, which effectively balances lubrication with the controlled release of bioactive substances, represents a highly promising therapeutic approach for osteoarthritis.

Assessment of harm reduction receipt and infectious diseases outcomes in United States Veterans with opioid use disorder and history of injection drug use

BackgroundInjection drug use (IDU) may lead to negative health outcomes and increased healthcare utilization. In US Veterans (USV) with opioid use disorder (OUD), there is sparse information about healthcare utilization, harm reduction prescription, and outcomes associated with IDU, including severe injection-related infections (SIRI). We assessed psychosocial factors, clinical outcomes, and harm reduction receipt in a cohort of USV with OUD, specifically focusing on persons who inject drugs (PWID).MethodsA retrospective cohort study was performed of USV aged ≥ 18 years with a diagnosis of OUD who presented to the Northport Veterans Affairs Medical Center (Long Island, NY) between 2012 and 2022. Demographics, psychosocial factors, history of human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection, and healthcare utilization were compared by IDU status. Prescription of medications for opioid use disorder, naloxone and pre-exposure prophylaxis (PrEP) for HIV were also compared by IDU status. SIRI episodes and associated sequelae were characterized in USV with IDU.ResultsA total of 502 USV with OUD were included and 216 (43%) were PWID. Mean age was 52.6 years. PWID were more likely to use multiple stimulants (14.4% PWID vs. 7.3% non-PWID, p < 0.011), be hospitalized with an infection (26.4% PWID vs. 12.2% non-PWID, p < 0.001) and had more frequent inpatient admissions (n = 5.5 PWID vs. n = 3.51 non-PWID, p = 0.003). Among PWID, 134 (62%) had a history of HCV infection, 9 (4.2%) had HIV, and 35 (16.2%) had at least one SIRI episode. PWID had a higher frequency of current (51.9% PWID vs. 38.5% non-PWID, p = 0.003) or previous MOUD use (45.8% PWID vs. 31.1% non-PWID, p < 0.001). Overall PrEP receipt in our cohort (0.46% PWID vs. 1.4% non-PWID, p = 0.4) was low.ConclusionsUSV with OUD and a history of IDU had a high prevalence of concurrent stimulant use, HCV, SIRI episodes, and were more likely to be hospitalized than USV with OUD and no history of IDU. Harm reduction strategies such as MOUD or PrEP, can help decrease the risk of infectious diseases, yet PrEP was underutilized in our population regardless of IDU status. USV with OUD would benefit from improved integration of OUD treatment, infectious diseases clinical care and harm reduction interventions.

Peer-assisted telemedicine for hepatitis C in people who use drugs: A randomized controlled trial.

Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet fewer than 10% of PWUD in the United States access HCV treatment and access is especially limited in rural communities. We randomized PWUD with HCV viremia and past 90-day injection drug or non-prescribed opioid use in seven rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV) versus peer-assisted referral to local providers (enhanced usual care; EUC). Peers supported screening and pre-treatment laboratory evaluation for all participants and facilitated telemedicine visits, medication delivery, and adherence for TeleHCV participants. Generalized linear models estimated group differences in HCV viral clearance (primary outcome) and HCV treatment initiation and completion (secondary outcomes). Of the 203 randomized participants (100 TeleHCV, 103 EUC), most were male (62%), white (88%), with recent houselessness (70%), and used methamphetamines (88%) or fentanyl/heroin (58%) in the past 30 days. Eighty-five of 100 TeleHCV participants (85%) initiated treatment versus 13 of 103 (12%) EUC participants (RR = 6.7, 95% CI 4.0 to 11.3, p<0.001). Sixty-three of 100 (63%) TeleHCV participants vs. 16 of 103 (16%) EUC participants achieved viral clearance 12 weeks after anticipated treatment completion date (RR = 4.1, 95% CI 2.5 to 6.5, p <0.001). The Peer TeleHCV treatment model substantially increased HCV treatment initiation and viral clearance compared to EUC. Replication in other rural and low-resource settings could further World Health Organization HCV elimination goals by expanding and decentralizing treatment access for PWUD. NCT04798521.

Gut microbiota profiling in injection drug users with and without HIV-1 infection in Puerto Rico

IntroductionThe full extent of interactions between human immunodeficiency virus (HIV) infection, injection drug use, and the human microbiome is unclear. In this study, we examined the microbiomes of HIV-positive and HIV-negative individuals, both drug-injecting and non-injecting, to identify bacterial community changes in response to HIV and drug use. We utilized a well-established cohort of people who inject drugs in Puerto Rico, a region with historically high levels of injection drug use and an HIV incidence rate disproportionately associated with drug use.MethodsUsing amplicon-based 16S rDNA sequencing, we identified amplicon sequence variants (ASVs) that demonstrated significant variations in the composition of microbial communities based on HIV status and drug use.Results and discussionOur findings indicate that the HIV-positive group exhibited a higher abundance of ASVs belonging to the genera Prevotella, Alloprevotella, Sutterella, Megasphaera, Fusobacterium, and Mitsuokella. However, Bifidobacteria and Lactobacillus ASVs were more abundant in injectors than in non-injectors. We examined the effect of drug use on the gut microbiome in both HIV-infected and non-infected patients, and found that multiple drug use significantly affected the microbial community composition. Analysis of differential of bacterial taxa revealed an enrichment of Bifidobacterium spp., Faecalibacterium spp., and Lactobacillus spp. in the multiple drug-injecting group. However, in the non-injecting group, Parabacteroides spp., Prevotella spp., Paraprevotella spp., Sutterella spp., and Lachnoclostridium spp. The presence of multiple drug-injecting groups was observed to be more prevalent. Our findings provide detailed insight into ASV-level changes in the microbiome in response to HIV and drug use, suggesting that the effect of HIV status and drug injection may have different effects on microbiome composition and in modulating gut bacterial populations.

Endogenous Endophthalmitis caused by Abiotrophia/Granulicatella

Purpose To describe a case of endogenous endophthalmitis caused by the bacterium Abiotrophia/Granulicatella adiacens, which clinically appeared consistent with fungal endophthalmitis, in a young patient with a history of intravenous (IV) drug use. Observations A 22-year-old male presented with one week of pain and decreased vision in the left eye. He had a history of IV heroin use. Slit lamp and dilated fundus exam revealed significant intraocular inflammation concerning for endogenous endophthalmitis. The initial clinical impression was of fungal endophthalmitis given the appearance of vitreous opacities consistent with fungal balls. However, vitreous sampling revealed Abiotrophia/Granulicatella adiacens, a species of fastidious gram-positive cocci formerly known as nutritionally variant streptococci. Conclusion We describe Abiotrophia/Granulicatella species causing endogenous endophthalmitis in a patient with a history of IV drug use. Abiotrophia/Granulicatella have not been described previously to cause endophthalmitis. This atypical case expands the spectrum of microorganism’s clinicians should consider when diagnosing and treating endogenous endophthalmitis.

Modular Synthetic Platform to Tailor Therapeutic-Specific Delivery in Injectable Hydrogels.

Injectable thermoresponsive hydrogels (thermogels), valued for their conformability and minimal invasiveness, are increasingly used as in situ forming implants for drug delivery and as regenerative scaffolds. These gels exhibit sol-to-gel phase transitions at body temperature. As localized depots and scaffolds, these gels determine the chemical and mechanical environments and could dramatically influence the release kinetics of drugs or the fate of cells. Current synthetic approaches for thermogels, however, often limit the ability to fully exploit interactions between the thermogel matrix and the encapsulated agent. In this study, we introduce a modular synthetic platform for creating a library of functionalized polyurethane thermogels that enables customization of gelation properties and intermolecular interactions. These thermogels can exhibit a wide range of stiffness, offer complementary ionic interactions, and enhance hydrophobic interactions and hydrogen bonding. By leveraging these tunable interactions between the thermogelling scaffold, functional groups, and encapsulated agents, we achieved sustained and controlled release, from days to over 6 months, for both low and high molecular weight drug analogs. Release profiles varied from monophasic to biphasic and triphasic depending on the compatibility between the thermogel properties and the encapsulated agents. The design rules identified here support the development of drug-specific formulations, facilitating precise, sustained, and modulated release tailored to therapeutic needs. Beyond providing an adaptable strategy for customizable injectable drug depots, this synthetic strategy lays the groundwork for future iterations of multi stimuli-responsive thermogels with enhanced bioactivity, advancing the potential for customizable, biointeractive therapeutic systems.

Nationwide Trends in Anesthetic and Analgesic Protocols for Spay-Neuter Clinics: A Survey of Practices and Preferences in the United States

Introduction: The advancement of spay-neuter procedures has been vital to the reduction of euthanized dogs and cats. Even though many spay-neuter clinics and shelters have adopted anesthesia protocols that align with best practices, there is currently little published data reporting trends among these clinics in the United States. The aim of this study was to document the most commonly used spay-neuter anesthetic/analgesic protocols. Methods: In 2017, a voluntary, anonymous web-based survey was distributed to shelters/clinics through the high quality, high volume spay-neuter (HQHVSN) veterinarians’ listserv and the ASV listserv. Results: One hundred and six facilities participated in the survey spanning 36 states in the United States. The most commonly used canine anesthesia premedication was acepromazine paired with an opioid, with acepromazine/hydromorphone and acepromazine/butorphanol representing 26% (24/91), and 23% (23/91) of the responses, respectively. Ketamine/midazolam was the most commonly used canine induction anesthetic representing 39% (35/91) of the responses. The most commonly used feline protocol was a total intramuscular anesthetic combination such as dexmedetomidine/ketamine/butorphanol (DKT) or Telazol/butorphanol/dexmedetomidine (TTDex) accounting for 39% (35/91) and 33% (30/91) of the responses, respectively. The majority of respondents administered an injectable non-steroidal anti-inflammatory drug (NSAID) to their canine and feline patients at 63% (67/106) and 59% (63/106)), respectively. Only 26% (25/98) of respondents used to-go-home (TGH) medications and only 40% (41/102) of respondents used local anesthetics. Overall protocol satisfaction was 86% (59/66). Conclusion: This survey identified that across a wide range of spay-neuter clinics there exists significant trends with regards to anesthetic and analgesic protocols.

Rate of hepatitis C reinfection after successful direct-acting antivirals treatment among people who inject drugs in Spain: the LIVERate study

BackgroundHepatitis C virus (HCV) reinfection following successful treatment threatens the achievement of HCV elimination. The primary aim of this study is to assess reinfection rate three years after sustained virologic response (SVR) in people who inject drugs (PWID) that are on opioid agonist treatment (OAT) who underwent anti-HCV treatment with interferon-free regimens.MethodsObservational, non-interventional, prospective, descriptive study carried out in Spanish tertiary public hospitals between 2017 and 2022. Participants comprised 186 adult HCV infected individuals, 85.5% males with a mean age (Standard Deviation, SD) of 50.1 (5.9). All were enrolled in an OAT program at baseline and had attained SVR 12 weeks after therapy completion with an interferon-free treatment. Baseline data were abstracted from medical chart information collected through the routine clinical practice.ResultsThe overall rate of HCV reinfection three years after SVR12 among PWID was 1.2 new cases per 100 person-years of follow-up at a median of 15.9 months. In the subgroup analyses, those with injection drug practice and without a stable housing had higher reinfection rates.ConclusionAlthough PWID in OAT present a low rate of reinfection by HCV after successful treatment, a closer monitoring in the first year and strengthening inter-consultations with services responsible for monitoring addiction in these patients will be crucial to reduce risky behaviors avoiding HCV reinfection.

Reaching people who use drugs with sexual and reproductive healthcare through syringe services programs: potential promise and missed opportunities

BackgroundPeople who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and differences in sexual and reproductive health among these groups.MethodsWithin a cohort study among people who use unprescribed opioids in New York City, we conducted a nested cross-sectional study from November 2021-August 2022 assessing sexual health with a survey (n = 120). The parent study measured baseline characteristics, and the cross-sectional study survey measured self-reported past-year SSP use and sexual and reproductive health. We estimated SSP use within gender, racial, and ethnic groups by IDU, and the prevalence of sexual and reproductive health outcomes by gender, race, ethnicity, and SSP use.ResultsAmong men (n = 61) and women (n = 54), SSP use was disproportionately low among Black participants irrespective of IDU. Women reporting SSP use had a higher prevalence of multiple, new, sex trade, and/or casual sex partners, history of STI symptoms, and lack of effective STI prevention, although women who did not use SSP had non-negligible levels of risk with variation between racial and ethnic groups. Among men, sexual and reproductive health varied across racial and ethnic groups but not as clearly by SSP use.ConclusionsSSP offer opportunity to address elevated STI risk among people who use drugs but may miss certain intersecting gender, race, and ethnic groups.