Intravenous Use Research Articles

Time to intravenous diuretic administration in patients hospitalized with heart failure: An observational study.

To help establish optimized treatment strategies for congestion in patients with acute heart failure, this study aimed to provide a detailed summary of real-world diuretic use in hospitalized patients with heart failure requiring urgent therapy in Japan. This observational study used a Japanese medical records database to extract data of patients admitted to hospital with a heart failure diagnosis and an intravenous diuretic prescription from the day before admission to 2days after. Time from hospital visit to first dose, second dose, and maximum dose of intravenous diuretics were determined. Patients were grouped according to whether they received diuretic modification, defined as an intravenous diuretic dose increase or concomitant use of other diuretics. Overall, 1577 patients were included in the study (without diuretic modification, n=1140 [72.3%]; with diuretic modification, n=437 [27.7%]). The study population was 49.5% female (n=780) and the mean age±standard deviation was 80.1±12.7years. Intravenous diuretic treatment was received within 1h of their hospital visit in 43.5% of patients (686/1577) and ≤2h in 16.4% of patients (258/1577). Among 437 patients with an inadequate response following their first dose, 42.1% received an intravenous dose titration, 56.5% received combination diuretics, and 1.4% received both. Over half of the patients (59.0% [258/437]) with diuretic modification received it after the first 24h of the hospital visit. The median time from hospital visit to first dose titration was similar to time to first combination diuretic use (18.6h and 17.0h, respectively). The mean±standard deviation duration of intravenous diuretic use was significantly longer for patients with versus without diuretic modification (6.3±5.2 vs. 3.7±3.2days), and a significantly greater proportion of patients (44.6% [195/437] vs. 35.0% [399/1140]) received repeated intravenous diuretic administration. Other characteristics/outcomes of intravenous diuretic use were similar with versus without diuretic modification, including in-hospital death (15.6% [68/437] vs. 13.9% [159/1140]) and mean±standard deviation length of hospitalization (21.9±14.7days vs. 22.1±21.2days). In Japan, real-world patterns of intravenous diuretic administration for patients with heart failure remains far from the time-sensitive approach recommended in Japanese, European, and United States guidelines.

Prophylactic intravenous immunoglobulin use in allogeneic stem cell transplantation; does intravenous immunoglobulin affect survival, sepsis, and engraftment time?

Abstract: BACKGROUND: Stem cell transplant recipients have an increase in various infections depending on the immunosuppression. The purpose is to explore the effect of the use of proflactıc intravenous immunoglobulin (IVIG) on transplant recıpıents. OBJECTIVE: It was aimed to examine the effect of IVIG on allogeneic stem cell transplantation. MATERIALS AND METHODS: In this study, sepsis status, infection focus causing sepsis, neutrophil and platelet engraftment time of patients the length of stay in the hospital at the time of the stem cell transplant, if the patient died, how many days after the transplant the event developed, and the data of the bone marrow transplant unit were reviewed retrospectively. One hundred and eleven patients who were given IVIG (400 mg/kg/week IVIG intravenous was given to the patients as a weekly prophylactic up to 100 days starting on the 7th day after transplantation) and 190 patients who did not receive IVIG were included in the study. RESULTS: There was no statistically significant difference between the IVIG groups in terms of gender, diagnosis, donor characteristics, and event (P > 0.05). Sepsis was observed significantly less in patients who were given IVIG compared to patients who were not given IVIG (P < 0.001). While it was observed that IVIG did not have a significant effect on platelet engraftment and discharge times (P > 0.05), neutrophil engraftment time was significantly higher in patients given IVIG compared to patients not given IVIG (P < 0.009). It was observed that the use of IVIG in patients with sepsis did not have a positive effect on survival. (with sepsis hazard ratio [HR]: 3.890 P = 0.001, IVIG given HR: 3.244 P = 0.035). CONCLUSION: It was observed that the use of IVIG in allogeneic stem cell transplantation was associated with a decrease in sepsis, but the use of IVIG did not have a positive effect on survival and could prolong neutrophil engraftment.

Eco-Friendly Mycogenic Synthesis of Iron Oxide Nanoparticles Using Volvariella volvacea and Unveiling its Potential as Antibiofilm and Anticancer Agents

This research explores the eco-friendly creation of functional, biocompatible nanomaterials through green chemistry, utilizing natural extracts over chemicals to produce metal and metal oxide nanoparticles. The study focuses on iron oxide nanoparticles synthesized with Volvariella volvacea (GIONP) and evaluates their physical, chemical, and biological traits, including their anticancer capabilities, against traditionally made IONPs (CIONP). GIONPs, confirmed by UV-visible spectroscopy and dynamic light scattering, showed enhanced stability and consistent size distribution. They also demonstrated smaller sizes via -Field Emission scanning electron microscopy analysis, and X-ray diffraction and Fourier transform infrared studies verified their crystalline structure and organic functional groups. Notably, GIONPs exhibited strong antioxidant properties, low toxicity to blood cells, promising for intravenous use, and greater antimicrobial and antibiofilm activities against various bacterial strains than CIONPs. The study revealed that both GIONPs and CIONPs exhibit a similar degree of toxicity towards MDA-MB 231 cancer cells. The internalization of GIONPs within these cells was verified through a Prussian blue assay and further supported by the concentration-dependent increase in intracellular iron levels post-treatment. These findings underscore the successful formulation of GIONPs that are not only biocompatible and eco-friendly but also capped with bioactive compounds, highlighting their promising applications in the field of biomedicine.

"K Cramps," Recurrent Abdominal Pain in a Patient with Chronic Ketamine Use: A Case Report.

Medical and nonmedical ketamine use is increasing in the United States. This will likely lead to an increase in emergency department (ED) visits in individuals experiencing associated side effects. Physicians will need to be able to effectively recognize and manage ketamine-related complications. A 31-year-old male with a three-year history of inhalational, intramuscular, and intravenous nonmedical ketamine use presented to the ED twice within a week with symptoms of severe atraumatic back pain, abdominal pain, and dyspepsia. A comprehensive workup, including advanced imaging, was unrevealing for identifiable causes, and the patient was discharged with instructions for primary care follow-up for further evaluation. The patient used information shared on Reddit, an online forum and social network, to identify that the cause of his pain was related to chronic ketamine use. Subsequently, upon discontinuation of ketamine, the pain improved in 24 hours. The patient self-navigated to addiction treatment. Emergency physicians should consider sequelae of chronic ketamine use as a possible cause for gastrointestinal and urologic symptoms in the ED. In addition to thorough examination and assessment for other acute medical problems, patients should be offered education, symptomatic treatment, and linkage to harm reduction and substance use disorder treatment services.

The Novel Platinum Analog Dicycloplatin Provides Reliable Growth Inhibition of Urothelial Carcinoma Cells In Vitro.

Platinum-based chemotherapies are a component of standard-of-care regimens for urothelial carcinoma (UC). These nephrotoxic drugs are often dose-limiting, with cisplatin and carboplatin being the most commonly used. Dicycloplatin (DCP) has better solubility and stability, with comparable efficacy and better tolerability. Some suggest the use of DCP as primary treatment for non-muscle-invasive bladder cancer. We exposed UC cell lines to DCP in vitro to assess its efficacy. A high grade (IV) in vitro UC cell line (TCCSUP) was exposed to varying concentrations of cisplatin (0-600 μg/ml), carboplatin (0-600 μg/ml), oxaliplatin (0-4.0 μg/ml), and DCP (0-350 μg/ml). Grade II-IV cells were exposed to varying concentrations of DCP (0-350 μg/ml) to assess time- and concentration-dependent growth inhibition, and simulate intravesical treatment. Growth inhibition was determined following 24, 48, and 72 h of exposure, using a tetrazolium dye to assess mitochondrial dehydrogenase activity. DCP, cisplatin, and carboplatin effectively achieved >90% cell kill at 72 h. Concentrations of 325 μg/ml DCP, 50 μg/ml cisplatin, and 600 μg/ml carboplatin were sufficient for >90% cell-kill, with cisplatin demonstrating the highest efficacy at the lowest concentration/time intervals. Dose- and time-dependent cell kill were demonstrated at varying concentrations of DCP in grade II-IV cell lines, including cells exposed intravesically. In vitro, DCP demonstrates cell-killing efficacy in a time- and concentration-dependent manner in grade II-IV UC cell lines, showing promise for its intravenous, oral, and intravesical use for bladder UC in both primary and adjuvant/neoadjuvant settings.

Intravenous injection of nattokinase-heparin electrostatic complex improves the therapeutic effect of advanced tumors by dissolving cancer-related thrombosis

AimsCancer-related thrombosis (CAT) is a common complication in cancer patients, significantly impacting their quality of life and survival prospects. Nattokinase (NK) has potent thrombolytic properties, however, its efficacy is limited by low oral bioavailability and the risk of severe allergic reactions with intravenous use. Heparin (HP) is a widely used anticoagulant in clinical settings. This study aimed to overcome the intravenous toxicity of NK and explore its effect on CAT in advanced tumors. Main methodsIn this study, NK-HP electrostatic complexes were constructed, and their safety and thrombolytic efficacy were verified through guinea pig allergy tests, mouse tail vein tests, and both in vivo and in vitro thrombolysis experiments. Additionally, an S180 advanced tumor model was developed and combined with sialic acid-modified doxorubicin liposomes (DOX-SAL) to investigate the impact of NK-HP on CAT and its antitumor effects in advanced tumors. Key findingsWe observed that NK-HP can eliminate the intravenous injection toxicity of NK, has strong thrombolytic performance, and can prevent thrombosis formation. Intravenous injection of NK-HP can enhance the antitumor effect of DOX-SAL by reducing the fibrin content in advanced tumors and increasing the levels of the cross-linked protein degradation product D-dimer. SignificanceThis study developed a method to eliminate the intravenous injection toxicity of NK, proposing a promising therapeutic strategy for CAT treatment, particularly for CAT in advanced tumors, and improving the efficacy of nano-formulations in anti-tumor therapy.

Development of a screening platform for the formulation of poorly water-soluble drugs as albumin-stabilized nanosuspensions using nab™ technology

The nanoparticle albumin bound™ (nab™) technology generally offers great potential for the formulation of poorly water-soluble drugs as albumin-stabilized nanosuspensions for intravenous use while avoiding solubilizers and cross-linking agents. The nab™ technology is a three-step process consisting of emulsification, high-pressure homogenization and solvent evaporation.Within this work, a screening approach was developed to predict whether active pharmaceutical ingredients are suitable for nab™ formulations. A design of experiments approach was used to investigate the effects of ultrasonic homogenization on an albumin-stabilized itraconazole nanosuspension. Based on this, a screening platform was developed, and subsequently evaluated and applied to a selection of poorly water-soluble drugs. The screening process to produce albumin-stabilized nanosuspensions consists of two process steps: Ultrasonic treatment, which combined emulsification and homogenization, followed by solvent evaporation. The results of the screening process were fully transferable to the standard three-step process of nab™ technology. In addition, based on drug screening, drug properties were highlighted that are important for the development of nab™ formulations.All in all, the nab™ technology is a promising but not universal formulation platform for poorly water-soluble drugs. Nevertheless, for some poorly soluble drugs it offers a valuable approach for the formulation of nanosuspensions for intravenous use.

A Randomized Trial of the Impact of Ferric Citrate on Erythropoietin and Intravenous Iron Use in Patients Receiving Dialysis

Introduction: Ferric citrate (FC) is an FDA-approved iron-based phosphate binder for adults with dialysis-dependent chronic kidney disease. This study investigated the impact of FC as the primary phosphate-lowering therapy on utilization of erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron. Methods: In this randomized, open-label, active-controlled, multicenter study (NCT04922645), patients on dialysis and receiving ESAs were randomized to receive FC or remain on standard of care (SOC) phosphate-lowering therapy for up to 6 months. Primary endpoints were the difference in change from baseline to efficacy evaluation period (EEP) in mean monthly ESA and IV iron doses. Secondary endpoints included treatment differences in hemoglobin, phosphate, TSAT, and ferritin levels. Results: Two hundred nine patients were randomized to FC and had a day 1 dosing visit (n = 103) or SOC (n = 106). The two groups had similar baseline laboratory characteristics; however, atherosclerotic CV disease, peripheral vascular disease, and congestive heart failure were more common in the SOC group. The mean treatment difference in ESA monthly dose was −30.8 μg (FC vs. SOC; p = 0.02). An absolute though non-statistically significant change in mean monthly IV iron dose of −37.2 mg (p = 0.17) was observed with FC. Mean hemoglobin, TSAT, and ferritin all increased from baseline to the EEP with FC versus SOC. Serious adverse events occurred in 28% of patients receiving FC versus 37% in those receiving SOC. Conclusions: In patients receiving dialysis, treatment with FC as compared to remaining on SOC phosphate binders resulted in reductions in mean monthly ESA and IV iron dose.

Metformin Is Associated With Improved Inflammatory Bowel Disease Outcomes in Patients With Type 2 Diabetes Mellitus: A Propensity-Matched Cohort Study.

Metformin exerts anti-inflammatory properties through a positive effect on oxidative stress, gut barrier integrity, and the gut microbiota. Our aim was to evaluate the influence of metformin on inflammatory bowel disease (IBD) outcomes in patients with type 2 diabetes mellitus (T2DM). We conducted a retrospective cohort study using the TriNetX database in patients with IBD and T2DM who initiated metformin vs oral hypoglycemics or insulin (control cohort) between August 31, 2002, and August 31, 2022. One-to-one propensity score matching was performed. Primary outcomes were need for intravenous (IV) steroid use or IBD-related surgery within 1, 2, and 3 years after metformin initiation. Our cohorts included 1323 patients with ulcerative colitis (UC) (mean age 58.7 ± 12.2 years, 50.1% female, 77.3% White) and 1278 patients with Crohn's disease (CD) (mean age 56.3 ± 12.6 years, 58.2% female, 76.5% White). At 1 year, patients with UC and CD were less likely to require IV steroids (UC: adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.34-0.59; P < .01; CD: aOR, 0.67; 95% CI, 0.53-0.85; P < .01). The decreased need for IV steroids persisted in all metformin groups at 2 and 3 years. Patients with CD were at a lower risk for IBD-related surgery at year 1 (aOR, 0.5; 95% CI, 0.31-0.81; P < .01), and this finding persisted at 3 years (aOR, 0.62; 95% CI, 0.43-0.89; P < .01). Metformin did not affect risk for surgery in patients with UC. Patients with IBD and T2DM on metformin had a decreased likelihood of worse IBD outcomes.

Association of intravenous digoxin use in acute heart failure with rapid atrial fibrillation and short-term mortality according to patient age, renal function, and serum potassium.

Intravenous digoxin is still used in emergency departments (EDs) to treat patients with acute heart failure (AHF), especially in those with rapid atrial fibrillation. Nonetheless, many emergency physicians are reluctant to use intravenous digoxin in patients with advanced age, impaired renal function, and potassium disturbances due to its potential capacity to increase adverse outcomes. We investigated whether intravenous digoxin used to treat rapid atrial fibrillation in patients with AHF may influence mortality in patients with specific age, estimated glomerular filtration rate (eGFR), and serum potassium classes. A secondary analysis of patients included in in the Spanish EAHFE cohort, which includes patients diagnosed with AHF in the ED. 45 Spanish EDs. Two thousand one hundred ninety-four patients with AHF and rapid atrial fibrillation (heart rate ≥100 bpm) not receiving digoxin at home, divided according to whether they were or were not treated with intravenous digoxin in the ED. The relationships between age, eGFR, and potassium with 30-day mortality were investigated using restricted cubic spline (RCS) models adjusted for relevant patient and episode variables. The impact of digoxin use on such relationships was assessed by checking interaction. The median age of the patients was 82 years [interquartile range (IQR) = 76-87], 61.4% were women, 65.2% had previous episodes of atrial fibrillation, and the median heart rate at ED arrival was 120 bpm (IQR = 109-135). Digoxin and no digoxin groups were formed by 864 (39.4%) and 1330 (60.6%) patients, respectively. There were 191 deaths within the 30-day follow-up period (8.9%), with no differences between patients receiving or not receiving digoxin (8.5 vs. 9.1%, P = 0.636). Although analysis of RCS curves showed that death was associated with advanced age, worse renal function, and hypo- and hyperkalemia, use of intravenous digoxin did not interact with any of these relationships ( P = 0.156 for age, P = 0.156 for eGFR; P = 0.429 for potassium). The use of intravenous digoxin in the ED was not associated with significant changes in 30-day mortality, which was confirmed irrespective of patient age or the existence of renal dysfunction or serum potassium disturbances.

Comparative Effectiveness of Upadacitinib and Tofacitinib in Ulcerative Colitis: A US Propensity-Matched Cohort Study.

There are limited real-world data comparing the effectiveness of upadacitinib and tofacitinib in patients with ulcerative colitis (UC). We conducted a retrospective cohort study using TriNetX, a multi-institutional database, to compare the effectiveness of upadacitinib and tofacitinib in patients with UC. The primary aim was to assess the risk of a composite outcome of hospitalization requiring intravenous steroids and/or colectomy within 6 and 12 months. One-to-one propensity score matching was performed for demographics, comorbid conditions, mean hemoglobin, C-reactive protein, albumin, and calprotectin, and prior UC medications including recent oral or intravenous steroid use between the cohorts. Risk was expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CI). There were 526 patients in the upadacitinib cohort (mean age 40.4 ± 16.3, 44.8% female sex, 76.6% White race) and 1,149 patients in the tofacitinib cohort (mean age 42 ± 17.1, 41.9% female sex, 76% White race). After propensity score matching, there was no significant difference in the risk of the composite outcome of need for intravenous steroids and/or colectomy within 6 months (aOR 0.75, 95% CI 0.49-1.09). However, there was a lower risk of the composite outcome (aOR 0.63, 95% CI 0.44-0.89) in the upadacitinib cohort compared with the tofacitinib cohort within 12 months. There was no difference in the risk of intravenous steroid use (aOR 0.70, 95% CI 0.48-1.02) but lower risk of colectomy (aOR 0.46, 95% CI 0.27-0.79). In sensitivity analysis, there was also a lower risk of the composite outcome (aOR 0.64, 95% CI 0.44-0.94), including lower risk of intravenous steroid use (aOR 0.67, 95% CI 0.45-0.99) and colectomy (aOR 0.49, 95% CI 0.26-0.92) in the upadacitinib cohort compared with the tofacitinib cohort within 12 months. This study utilizing real-world data showed that upadacitinib was associated with improved disease-specific outcomes at 12 months compared with tofacitinib in patients with UC.

Intravenous esketamine as an adjuvant for sedation/analgesia outside the operating room: a systematic review and meta-analysis.

This study was conducted to evaluate the safety and efficacy of intravenous esketamine as an adjuvant for sedation or analgesia outside the operating room in adults and children. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus were searched for potential randomized controlled studies randomized controlled trials comparing drug combinations of esketamine to any other single or combination drug regimens for sedation or analgesia outside the operating room. Twenty-five studies with a total of 3,455 participants were included in this review. The pooled results of adults showed that compared with drug regimens of the control group, intravenous esketamine combinations were significantly associated with decreased risk of oxygen desaturation (RR = 0.49, 95% CI = [0.34, 0.70]); hypotension (RR = 0.38, 95% CI = [0.31, 0.46]); bradycardia (RR = 0.23, 95% CI = [0.12, 0.43]); injection pain (RR = 0.37, 95% CI = [0.25, 0.53]); body movement (RR = 0.60, 95% CI = [0.41, 0.88]); and propofol consumption (SMD = -1.38, 95% CI = [-2.64, -0.11]), but an increased risk of psychiatric symptoms (RR = 3.10, 95% CI = [2.11, 4.54]) (RR = relative risk; CI = confidence intervals; SMD = standardized mean difference). Subgroup analysis showed that only the combination of esketamine and propofol significantly reduced the above incidence of respiratory and cardiovascular adverse events in adults. In addition, the pooled results of children showed that compared with drug regimens of the control group, esketamine and propofol co-administration significantly reduced the risk of hypotension (RR = 0.59, 95% CI = [0.37, 0.95]) but increased the risk of visual disturbance (RR = 6.62, 95% CI = [2.18, 20.13]) and dizziness (RR = 1.99, 95% CI = [1.17, 3,37]). Subgroup analysis indicated that esketamine>0.5mg/kg significantly reduced the incidence of hypotension, but increased the risk of dizziness in children. Intravenous use of esketamine, particularly in combination with propofol, may improve the safety and efficacy of sedation and analgesia outside the operating room, although the potential for psychiatric side effects warrants attention. Future research is recommended to investigate the role of esketamine with agents other than propofol.

Defining complicated urinary tract infection and route of antibiotics in children presenting to the emergency department: a cohort study using the Melbourne RUPERT clinical score

ObjectivesMost children with uncomplicated urinary tract infections (UTI) can be managed with oral antibiotics. However, identifying those likely to fail oral and need intravenous antibiotics due to complicating features at...

Long-term effect of intravenous antimicrobial use in a pharmacist-led ASP at a small Japanese acute care hospital

Background: Antimicrobial resistance (AMR) remains a crucial, healthcare issue for which many countries have devised a national action plan. In Japan as well, antimicrobial stewardship programs (ASP) are being implemented in acute care hospitals under this policy framework. Clinical pharmacists play a central role in ASP, often jointly with infectious disease (ID) physicians. However, in Japan, a shortage of ID physicians has resulted in some ASP being led solely by pharmacists. While reports of the short-term effects of this situation are emerging, the long-term impact of pharmacist-led ASP is still largely unknown in Japan. The present study retrospectively examined the long-term effects of pharmacist-led ASP in a small, Japanese, acute care hospital. Method: The present study examined a pharmacist-led ASP in an acute care hospital (287 beds) in Japan which was launched in August 2015 and assessed the duration of therapy per 1000 patient-days (DOT) as the primary outcome by comparing the pre-intervention period (April 2013-July 2015) with the intervention period (August 2015-March 2023) using linear regression analysis. Additionally, segmented time-series analysis was conducted for each, additional intervention, and the impact of reduced activity due to the coronavirus disease 2019 (COVID-19) pandemic during the intervention. The DOT at the study center were compared with the national average of facilities implementing ASP. Result: While the DOT for all intravenous antimicrobials showed a slight increase on linear regression (r=0.01; P=0.1), the DOT of antipseudomonal intravenous antimicrobials significantly decreased (r=-0.027; P &lt; 0 .01). Moreover, a significant reduction in DOT was observed immediately after the initiation of prospective review and feedback for carbapenems and daily prospective review and feedback for all intravenous antimicrobials (-3.2 and -2.4; P &lt; 0 .001 for the intercept). An increase in DOT was observed during the COVID-19 pandemic-related reduction in activity time, and a rapid decline was observed upon the resumption of activities. Conversely, the average, nationwide DOT significantly increased for all intravenous antimicrobials as well as for antipseudomonal intravenous antimicrobials (r=0.02 and r=0.004; P &lt; 0 .01) Conclusion: Sustaining an effective, pharmacist-led antimicrobial stewardship program led to a continual decrease in the DOT of antipseudomonal intravenous antimicrobials in a small, Japanese, acute care hospital despite a nationwide increase in their use following implementation of the national AMR action plan. Detailed analysis of pharmacists’ activities across multiple facilities is necessary to verify these effects.

"I Can't Get No Satisfaction"-Psychosocial Aspects and Awareness of Negative Impacts in Chemsex Users: Results from an Anonymous Online Survey.

Chemsex is the interplay of substance use by men who have sex with men (MSM) in sexual contexts. The minority stress model and the identity process theory are explanatory models. In this study, we investigated whether (i) differences in certain psychosocial aspects (i.e., shame, aspects of queer identity, and sexual self-concepts) exist between chemsex users and non-users, and (ii) which factors influence an awareness of negative impacts in chemsex users. We conducted an anonymous, cross-sectional, online survey, including sociodemography, sexual history, history of substance use, validated scales for shame-proneness, aspects of queer identity, and sexual self-concepts. Our analysis comprised descriptive statistics, t-tests, Spearman's correlations, and a multiple linear regression model. We recorded a total of 3257 datasets with 107 chemsex users. Chemsex users showed higher rates for risky sexual behavior. Values for shame proneness, more negative aspects of queer identity, and sexual self-concepts were elevated in chemsex users with an awareness of negative impacts. Sexual anxiety, intravenous substance use, and having had a difficult process coming out were significant predictors of feeling negative impacts. Aspects of shame, queer identity aspects, and sexual self-concepts play an important role in the field of chemsex. Different explanatory models seem to be relevant for different subgroups of chemsex users. Chemsex users with an awareness of a problem were particularly vulnerable and distressed but had the highest motivation for change. Prevention, counseling, and care might profit from the inclusion of these aspects. Further anti-stigma campaigns and a specialization of the healthcare system are needed. Registration: DRKS00022336, date: 29th of October, 2020.

The Subjective Sexual Effects of Intravenous Methamphetamine Use in Women

Purpose: This study aimed to identify the sexual effects of methamphetamine on female users and determine the factors that encourage continued use of this substance. Methods: This structured interview study was approved by the Institutional Review Board at Louisiana State University Health Shreveport. The research participants were female volunteers that reported either currently or previously using methamphetamine. One study team member conducted all the interviews similarly to reduce variability between interviews. This individual was a doctorate-level addiction specialist to ensure the integrity and value of the data collection. All interviews were conducted in private offices at the Council on Alcoholism and Drug Abuse of Northwest Louisiana (CADA) facility in Bossier City, LA, between January 25, 2013, and October 7, 2014. Each volunteer provided informed consent to participate in the study. The specialist asked study subjects open-ended questions, and each conversation lasted approximately one hour. The specialist started each interview with an inquiry regarding the participant’s experiences with methamphetamine. The interviewer would particularly ask about the activities in which that participant would become involved immediately after using methamphetamine. The research subject was given time to discuss any sexual effects of using this stimulant without any prompting by the interviewer. If the study participant did not broach this topic during the interview, the specialist would ask them, “How does methamphetamine make you feel?” This “trigger” question was developed with the primary objective of the study in mind, which was identifying the sexual effects of methamphetamine use on females. Descriptive statistical analysis was performed on the data collected from the interviews. Results: Fifty-six interviews were conducted over 1.5 years. The mean age of the research subjects was determined to be 34.5 (± 10.2; range: 18 to 56). The entire study population was comprised of white females. Fifty (90%) of the study subjects utilized methamphetamine through the intravenous route. Most of these intravenous users (96%) had smoked, snorted, or ingested the substance prior to injecting the substance. Forty-four (88%) of the research participants who engaged in intravenous methamphetamine use reported feeling sexual arousal and an immediate sensation of pleasure indistinguishable from that attributed to orgasm when they injected the substance. The methamphetamine had to be of “sufficient amount and of better quality,” according to these subjects, to elicit this effect. None of the individuals interviewed reported a feeling similar to orgasm when they smoked or snorted methamphetamine. Many subjects stated that they engaged in intravenous methamphetamine use as frequently as every two hours to keep experiencing the sexual response, even if they still felt intoxicated. Twelve (21%) of the subjects reported being directed towards intravenous methamphetamine use by other females describing the sexual effects. Twenty-three (47%) of the participants recounted immediate “vapors,” which were described as “cough” or “taste” of the drug. None of the subjects said they had previously shared the sexual component of their experience with methamphetamine use with medical providers. All participants recounted disinhibition regarding sex but not social interactions. They also declared indifference to the consequences of high-risk sexual behavior and unsafe use of needles. Four subjects admitted avoiding hospital settings because they feared their methamphetamine use would be discovered. Conclusion: Female study participants who currently use or previously used methamphetamine reported a sexual response to intravenous use of the substance. Females who use methamphetamine were drawn toward intravenous use for the sexual experience, and those who use intravenous methamphetamine increase the frequency of use to reexperience the sexual response. These findings indicate that the sexual effects attributed to intravenous methamphetamine may contribute to its ongoing and recurrent use.

Use of glucagon-like peptide-1 receptor agonists for type 2 diabetes mellitus and outcomes of inflammatory bowel disease.

Glucagon-like peptide-1 receptor agonists (GLP-1RA) show anti-inflammatory properties. To evaluate their clinical impact on inflammatory bowel disease (IBD) outcomes. Retrospective cohort study utilising the TriNetX database comparing IBD-specific outcomes in patients with ulcerative colitis (UC) or Crohn's disease (CD) and type 2 diabetes mellitus (T2DM) on GLP-1RA compared to oral hypoglycaemic agents. The primary outcome was hospitalisation requiring intravenous steroids and IBD-related surgery within 3 years. We performed 1:1 propensity score matching (PSM) for demographics, co-morbid conditions, BMI, laboratory values, HbA1c, and IBD medications including steroids. We identified 1130 patients in the UC GLP-1RA cohort (mean age: 58.9 ± 11.6 years, 56.3% female, 70.2% White, 57.2% with obesity) and 1140 patients in the CD GLP-1RA cohort (mean age: 56.7 ± 11.5, 61.9% female, 73.6% White, 56.2% with obesity). After PSM, there was no difference in the risk of intravenous steroid use (aHR: 1.21, 95% CI: 0.92-1.59) but a lower risk of colectomy (aHR: 0.37, 95% CI: 0.14-0.97) between the UC GLP-1RA and control cohort. There was no difference in the risk of intravenous steroid use (aHR: 1.04, 95% CI: 0.80-1.34) but a lower risk of surgery (aHR: 0.55, 95% CI: 0.36-0.84) between the CD GLP-1RA and CD control cohort. There was no difference in the risk of oral steroid use or advanced therapy initiation in the UC and CD GLP-1RA than control cohorts. We found an association between lower risk of IBD-related surgery and GLP-1RA use for T2DM in patients with UC or CD.

Empirical assessment of wounds among people who use substances

BackgroundWounds are a significant source of morbidity among people who use substances (PWUS). This project sought to identify the incidence and severity of wounds among PWUS in the South Bronx, a region of New York City with one of the highest morbidities of substance use disorder. MethodsThis study recruited PWUS within the past 30 days. Research staff were trained to document the presence and severity of wounds. The primary outcome measure was the incidence of wounds. Acceptability of on-the-street wound care was assessed by the number of participants encountered. The association between participant characteristics and wounds was also evaluated. ResultsIn total, 586 PWUS were assessed (19.4 % female: 69 % Hispanic; 23 % Black; 5 % White). Heroin (65.7 %) and psychostimulants (58.3 %) were the most commonly used drugs. Approximately 23 % of outreach recipients disclosed a wound. Among those with a wound, 60.9 % reported one wound, 27.8 % had two wounds, and 11.3 % had three or more wounds. Small wounds (approximately the size of a cherry) were the most common (78.6 %). Recent use of stimulants or heroin, along with intravenous use of any substance were significantly associated with having a wound. ConclusionsThis study found that drug-related wounds were common among PWUS. Toxicology data from other sources indicate that xylazine was present in the NYC market at the time, though its prevalence among the current sample is difficult to determine. The occurrence and severity of substance-related wounds in NYC should continue to be monitored as a function of changes in the xylazine adulteration.

Alpha2 Agonist Use in Critically Ill Adults: A Focus on Sedation and Withdrawal Prevention.

The management of sedation in critically ill adults poses a unique challenge to clinicians. Dexmedetomidine, an α2 agonist, has a unique mechanism and favorable pharmacokinetics, making it an attractive intravenous option for sedation and delirium in the intensive care unit. However, patients may be at risk for withdrawal with prolonged use, adding to the complexity of sedation and agitation management in this patient population. Enteral α2 agents have the benefit of cost savings and ease of administration, thus playing a role in the ability to decrease intravenous sedative use and prevent dexmedetomidine withdrawal. Clonidine and guanfacine are the two most common enteral α2 agents utilized for this purpose, however, there is a paucity of evidence regarding the comparative benefit between the two agents. The decision to use one vs the other agent should be determined based on their differing pharmacology, pharmacokinetics, and side effect profile. The most effective dosing strategy for these agents is also unknown. Ultimately, more robust literature is required to determine enteral α2 agonists place in therapy. This narrative review evaluates the currently available literature on the use of α2 agonists in critically ill adults with an emphasis on sedation, delirium, and withdrawal.

A Retrospective Case Series Study of Alcaligenes faecalis Pneumonia

Background: The potentially developing human pathogen Alcaligenes faecalis is a gram-negative, nonfermenting bacterium. Treatment of A. faecalis infections is frequently difficult due to increased resistance to many antibiotics, such as β-lactam antibiotics, aminoglycosides, and quinolones. In the literature, A. faecalis pneumonia has never been documented in a case series study. Here, we provide a case series study of patients with A. faecalis pneumonia. Objectives: The aim of this study was to elucidate the clinical characteristics, management strategies, and outcomes of A. faecalis pneumonia patients. Methods: Patients with A. faecalis pneumonia between January 2014 and December 2019 were included in a retrospective investigation. We examined the clinical outcomes of patients with A. faecalis pneumonia, together with the risk factors for pneumonia, prior intravenous antibiotic use within 90 days, respiratory secretion culture results, antibiotic sensitivity test results, and other variables. Results: Observations revealed eight patients with A. faecalis pneumonia, including six males and two females. The mean age of patients was 70 years. These eight patients shared risk factors for pneumonia. Six patients were discharged, and two patients died as a result of A. faecalis pneumonia. Two patients with pneumonia caused by extensively drug-resistant A. faecalis were identified. Conclusions: Rare cases of A. faecalis pneumonia have been documented in the literature. Recently, A. faecalis has developed extensive drug resistance. To treat pneumonia caused by A. faecalis with substantial antibiotic resistance, either polymyxin B or tigecycline is needed. The clinical outcome is typically satisfactory when A. faecalis pneumonia patients receive appropriate antibiotic therapy, but cases of fatal pneumonia have been documented in the literature.