Non-drug Users Research Articles

Preadmission Antihypertensive Drug Use and Sepsis Outcome: Impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs)

Several studies have reported improved sepsis outcomes when certain preadmission antihypertensive drugs, namely, calcium channel blockers (CCBs), are used. This study aims to determine whether preadmission antihypertensive drug use, especially angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), is associated with decreased total hospital mortality in sepsis. This study was conducted using the unique database of a sepsis cohort from the National Health Insurance Research Database in Taiwan. Frequency matching for age and sex between preadmission antihypertensive drug users (study cohort) and nonusers (comparison cohort) was conducted. The primary outcome was total hospital mortality. Logistic regression analyses were performed to calculate the odds ratios (ORs) of important variables. Further joint effect analyses were carried out to examine the impacts of different combinations of antihypertensive drugs. A total of 33,213 sepsis antihypertensive drug use patients were retrieved as the study cohort, and an equal number of matched sepsis patients who did not use antihypertensive drugs were identified as the comparison cohort. The study cohort had a higher incidence rate of being diagnosed with septic shock compared with the comparison cohort (4.36%-2.31%, P < 0.001) and a higher rate of total hospital mortality (38.42%-24.57%, P < 0.001). In the septic shock condition, preadmission antihypertensive drug use was associated with a decreased adjusted OR (OR = 0.66, 95% confidence interval [CI], 0.55-0.80) for total hospital mortality, which was not observed for the nonseptic shock condition. Compared with antihypertensive drug nonusers, both ACEI and ARB users had decreased adjusted ORs for total hospital mortality in sepsis (adjusted OR = 0.93, 95% CI, 0.88-0.98 and adjusted OR = 0.85, 95% CI, 0.81-0.90); however, CCB, beta-blocker, and diuretic users did not. In the septic shock condition, ACEI, ARB, CCB, and beta-blocker users all had decreased ORs for total hospital mortality. Joint effect analysis showed ACEI use, except in combination with diuretics, to be associated with a decreased adjusted OR for total hospital mortality in sepsis. Similar results were observed for ARB users. Preadmission ACEI or ARB use is associated with a decreased risk of total hospital mortality, regardless of a nonshock or septic shock condition.

Cross-sectional associations between angiotensin-converting enzyme inhibitor use and cancer diagnosis in US adults.

The objective of the present study was to investigate the association between angiotensin-converting enzyme (ACE) inhibitor use and cancer incidence (overall, and breast, prostate, and colorectal cancers specifically) in a large representative sample of US adults. Cross-sectional data on cancer diagnosis, timing of cancer diagnosis, ACE inhibitor use, and other characteristics were extracted from 49 512 adults aged ≥ 20years participating in the National Health and Nutrition Examination Survey (1999-2016). Multivariable-logistic and propensity score matching (PSM) regressions examined the relationship between pre-diagnosis use of ACE inhibitors and diagnosis of all cancers, and breast, prostate, and colorectal cancers specifically. Overall, we observed an increased likelihood of cancer diagnosis [odds ratio (OR) 1.269, 95% confidence interval (CI) 1.088-1.480] among those who used ACE inhibitors compared to non-ACE inhibitor use, and for prostate cancer diagnosis (OR 1.438, 95% CI 1.090-1.897), after adjusting for age, sex, body mass index, race/ethnicity, educational attainment, physical activity, alcohol drinking status, smoking status, and high blood pressure. PSM regression retrieved more conservative estimates such that the increased likelihood of cancer diagnosis was only observed when comparing ACE inhibitor users with non-drug users (OR 1.022, 95% CI 1.016-1.027). Compared with non-ACE inhibitor use, ACE inhibitor use was associated with an increased risk of prostate cancer. In conclusion, in this large representative sample of US adults, it was found that ACE inhibitor use may have a marginal influence on some cancers.

On the relevance of cocaine detection in a fingerprint

The finding that drugs and metabolites can be detected from fingerprints is of potential relevance to forensic science and as well as toxicology and clinical testing. However, discriminating between dermal contact and ingestion of drugs has never been verified experimentally. The inability to interpret the result of finding a drug or metabolite in a fingerprint has prevented widespread adoption of fingerprints in drug testing and limits the probative value of detecting drugs in fingermarks. A commonly held belief is that the detection of metabolites of drugs of abuse in fingerprints can be used to confirm a drug has been ingested. However, we show here that cocaine and its primary metabolite, benzoylecgonine, can be detected in fingerprints of non-drug users after contact with cocaine. Additionally, cocaine was found to persist above environmental levels for up to 48 hours after contact. Therefore the detection of cocaine and benzoylecgonine (BZE) in fingermarks can be forensically significant, but do not demonstrate that a person has ingested the substance. In contrast, the data here shows that a drug test from a fingerprint (where hands can be washed prior to donating a sample) CAN distinguish between contact and ingestion of cocaine. If hands were washed prior to giving a fingerprint, BZE was detected only after the administration of cocaine. Therefore BZE can be used to distinguish cocaine contact from cocaine ingestion, provided donors wash their hands prior to sampling. A test based on the detection of BZE in at least one of two donated fingerprint samples has accuracy 95%, sensitivity 90% and specificity of 100% (n = 86).

Adverse Effects of Anticholinergic Drugs on Cognition and Mobility: Cutoff for Impairment in a Cross-Sectional Study in Young–Old and Old–Old Adults

Drugs with anticholinergic properties are commonly prescribed in older adults despite growing evidence of their adverse outcomes. Several issues regarding these detrimental effects remain unresolved, such as the putative existence of a threshold above which anticholinergic drug consumption impairs cognitive or mobility performance. We aimed to investigate the number of anticholinergic drugs and the anticholinergic burden that leads to mobility or cognitive impairment and compare the effects in community-dwelling older adults in two age groups ("young-old" 55-74 vs. "old-old" ≥ 75years). In a cross-sectional study, we identified drugs with anticholinergic (antimuscarinic) properties using the Anticholinergic Drug Scale. Cognition was assessed using the Mini Mental State Examination (MMSE) and the Trail Making Test (TMT-A and TMT-B), and mobility was assessed using the Timed Up and Go (TUG) test. The study population consisted of 177 volunteers, 114 of whom were classed as young-old and63 were classed as old-old adults. Despite the lack of cutoff values for impaired outcomes in young-old adults, impaired MMSE were significantly more numerous in users than in nonusers of anticholinergic drugs. In old-old adults, receiver operating characteristic (ROC) curve analysis indicated that taking a single anticholinergic drug per day was associated with impaired TMT-B completion time, TMT difference score (B-A), and TUG scores. The cutoff for anticholinergic burden was also one for these same outcomes. Based on these cutoff values, multivariate logistic regressions in old-old adults showed that the increased risk of impaired cognition and mobility was independent of confounding factors, including comorbidities. They also suggested that anticholinergic drugs would affect mobility through executive functions. Drugs with anticholinergic (antimuscarinic) properties are associated with cognitive impairment in individuals as young as 55years, and only one such drug per day, regardless of its anticholinergic burden, is associated with both impaired cognition and impaired mobility in old-old adults. Therefore, wherever possible, clinicians should avoid prescribing drugs with anticholinergic properties.

Теоретические и практические аспекты профилактической работы в борьбе с наркоманией

The aim of the work is to study the theoretical and practical aspects of the emergence of drug addiction, types of preventive work in the fight against drug addiction, the peculiarities of its spread among adolescents. An assessment of the development of the drug situation in the Tambov Region for 2019 is given. According to the totality of criteria, the situation in the region is tense. The most difficult state is noted according to the following criteria: the proportion of drug-related crimes in the total number of registered criminal acts (“pre-crisis”); involvement of drug users in drug trafficking (“heavy”); criminality of drug addiction (“satisfactory”); the proportion of persons convicted of drug-related crimes in the total number of convicted persons (“heavy”); the proportion of young people in the total number of persons convicted of drug offenses (“tense”). The drug market of the Tambov Region is represented by synthetic drugs and their analogues, drugs of the cannabis group (marijuana, hashish), heroin. The main methods of the preventive fight against drug addiction in the Tambov Region are listed. Presumptive trends in drug trafficking associated with the use of “non-contact” methods of selling drugs, further merging of drug-related crime with cybercrime, involvement of non-drug users in drug trafficking, as well as an increase in the number of drug addicts among minors are indicated.

Distinguishing between Contact and Administration of Heroin from a Single Fingerprint using High Resolution Mass Spectrometry.

Fingerprints have been proposed as a promising new matrix for drug testing. In previous work it has been shown that a fingerprint can be used to distinguish between drug users and nonusers. Herein, we look at the possibility of using a fingerprint to distinguish between dermal contact and administration of heroin. Fingerprint samples were collected from (i) 10 patients attending a drug rehabilitation clinic, (ii) 50 nondrug users and (iii) participants who touched 2 mg street heroin, before and after various hand cleaning procedures. Oral fluid was also taken from the patients. All samples were analyzed using a liquid chromatography—high resolution mass spectrometry method validated in previous work for heroin and 6-AM. The HRMS data were analyzed retrospectively for morphine, codeine, 6-acetylcodeine and noscapine. Heroin and 6-AM were detected in all fingerprint samples produced from contact with heroin, even after hand washing. In contrast, morphine, acetylcodeine and noscapine were successfully removed after hand washing. In patient samples, the detection of morphine, noscapine and acetylcodeine (alongside heroin and 6-AM) gave a closer agreement to patient testimony on whether they had recently used heroin than the detection of heroin and 6-AM alone. This research highlights the importance of washing hands prior to donating a fingerprint sample to distinguish recent contact with heroin from heroin use.

Modeling tuberculosis patients using loglinear models

Tuberculosis (TB) patients usually get infected by tuberculosis bacteria called Mycobacterium tuberculosis which can spread from one person to another through air. TB cases normally infect the lungs (Pulmonary TB) and in some other cases it infects other organs such as brain, heart, spine, lymph nodes, adrenal gland and intestines (Extrapulmonary TB). However, patients who are infected with tuberculosis bacteria may have complications due to other factors that can delay the process of healing. Using loglinear modelling, this study will examine whether types of TB is strongly associated with patient’s age, gender, whether or not they smoke, have HIV and into drug use. Records of 477 TB patients obtained from a previous related study are used in the modelling process where five loglinear models are compared to find the most parsimonious model that will determine the strength of the association between the variables. Likelihood ratio G2, p-values, expected values and standardized residuals are used in the analysis. Based on the comparisons of the loglinear models, homogeneous model is found to be the most parsimonious compared to independence and joint models. The analysis based on the homogenous loglinear model show that that the estimated odds of patients who smoke is 2 times more likely to have a Pulmonary TB compared to the non-smokers. Also patients who are drug users are 8 times more likely to have a Pulmonary TB compared to patients who are non-drug users. Hence, a recommendation for the healthcare providers is to give more attention to patients in these categories.

Trends of antidementia drugs use in outpatients with Alzheimer's disease in six major cities of China: 2012-2017.

Alzheimer's disease is a devastating neurodegenerative disease that requires pharmacological intervention. We conducted a descriptive study using pharmacy prescription data of antidementia drugs. Prescription information of 99 541 patients was obtained from 55 hospitals. Overall the number of Alzheimer's disease outpatients of sampling days increased from 10 239 in 2012 to 20 546 in 2017. The main age range of patients suffering Alzheimer's disease was 75-84, while the patients aged above 85 was increasing. Nonusers of antidementia drugs, cholinesterase inhibitors (ChEIs) and memantine slowly decreased over the study period. The percentage of patients taking ChEIs and ChEIs-combined memantine increased. The most frequently prescribed ChEI was donepezil. These results are mostly in line with the guideline recommendations and clinical evidence during the study period. Efforts should be made to reduce the number of nonusers and optimize the use of antidementia drugs.

Midnight salivary cortisol secretion associated with high systolic blood pressure in type 1 diabetes.

ObjectiveTo explore associations between high midnight salivary cortisol (MSC) secretion and high blood pressure (BP) in type 1 diabetes (T1D).MethodsCross-sectional study of 196 adult patients with T1D (54% men). Associations between high MSC (≥9.3 nmol/L) and high systolic BP (>130 mmHg), and high diastolic BP (>80 mmHg) were explored for all patients, users and non-users of antihypertensive drugs (AHD). Adjustments were performed for age, sex, diabetes-related variables, p-creatinine, smoking, physical inactivity, depression and medication.ResultsThe prevalence of high MSC differed between patients with high and low systolic BP in all 196 patients: 39 vs 13% (P = 0.001); in 60 users of AHD: 37 vs 12% (P = 0.039), and in 136 non-users of AHD: 43 vs 13% (P = 0.012). Significant associations with high systolic BP were for all patients: physical inactivity (adjusted odds ratio (AOR) 6.5), high MSC (AOR 3.9), abdominal obesity (AOR 3.7), AHD (AOR 2.9), age (per year) (AOR 1.07), and p-creatinine (per µmol/L) (AOR 1.03); for 60 users of AHD: high MSC (AOR 4.1) and age (per year) (AOR 1.11); for 136 non-users of AHD: abdominal obesity (AOR 27.4), physical inactivity (AOR 14.7), male sex (AOR 9.0), smoking (AOR 7.9), and age (per year) (AOR 1.08). High MSC was not associated with high DBP.ConclusionsIn adult patients with T1D, high systolic BP was associated with physical inactivity, high MSC secretion, abdominal obesity, p-creatinine, age, and AHD, the latter indicating treatment failure.

Stimulant Use and Study Protocol Completion: Assessing the Ability of Men Who Have Sex with Men to Collect Dried Blood Spots for Laboratory Measurement of HIV Viral Load.

Stimulant use is associated with higher HIV viral load (VL) and sexual HIV transmission risk among men who have sex with men (MSM) living with HIV. There is little research on willingness of drug users living with HIV to fully participate in studies, especially those involving self-collection of biomarker data. This study presents findings from an at-home dried blood spot collection study measuring laboratory-quantified VL among U.S. HIV-positive MSM who reported high-risk sexual behavior and/or suboptimal antiretroviral therapy (ART) adherence to assess the association between drug-use behavior and (1) ability to complete a study protocol and (2) VL outcomes. Among recruited participants (n = 766), 35% reported stimulant drug use (amphetamines, cocaine, crack, crystal meth, ecstasy, or a combination of stimulant drugs), 39% reported using other drugs (heroin, marijuana, prescription opioids, and others), and 27% reported no drug use in the past 3 months. In all, 61% of enrolled participants completed the study protocol. Stimulant drug users were less likely (ARR 0.84; 95% CI 0.72-0.98) to complete the protocol than other drug users. Furthermore, other drug users were significantly less likely than non-drug users (ARR 0.52; 95% CI 0.28-0.97) to have an HIV VL result ≥ 1500 copies/mL. This study provides important estimates regarding the likelihood of participation in biomedical research activities among HIV-positive MSM with varying drug-use behaviors, showing that it is feasible to conduct such biomedical studies with drug-using MSM who report high-risk sexual behavior and struggle with their ART adherence.

Distinct inflammatory profiles in HIV-infected individuals under antiretroviral therapy using cannabis, cocaine or cannabis plus cocaine

To evaluate the effects of cannabis and/or cocaine use on inflammatory, oxidative stress status and circulating monocyte subsets in HIV-infected individuals under antiretroviral therapy. Soluble CD14 (sCD14), intestinal fatty acid-binding protein (IFABP), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP) and oxidative stress markers were examined. The monocyte subsets and their activation and cytokine production by peripheral blood mononuclear cells (PBMCs) of HIV-1 infected individuals upon lipopolysaccharide (LPS)-stimulation were also investigated. sCD14, IFABP, TNF-α, IL-6, IL-8 and IL-10 levels were evaluated using ELISA, CRP by turbidimetry; lipid peroxidation (TBARS) spectrofluometrically and total thiol levels by using 5-5'-dithio-bis (2-nitrobenzoic acid) reagent. Monocyte subsets and activation were assessed by flow cytometry. All HIV-infected drug user groups showed higher sCD14 levels compared with HIV+ nondrug users. IFABP was increased in HIV+ drug-users in relation to healthy individuals. Cannabis use lowered the percentages of inflammatory, nonclassical, activated-classic and activated-inflammatory monocytes. Cocaine users showed increased plasmatic TNF-α and TBARS levels, decreased thiols content and lower activated-classic and inflammatory-monocyte percentages. Cannabis-plus-cocaine use increased CRP, IL-8 and IL-6/IL-10 ratio, but decreased thiol content, and inflammatory and activated-classic monocyte percentages. PBMCs of cannabis and cannabis-plus-cocaine users showed low-potential cytokine production either spontaneously or under LPS-stimulation. In HIV infection, the use of cannabis induces predominantly an anti-inflammatory profile. The use of cocaine and cannabis-plus-cocaine showed a mixed pro-inflammatory and anti-inflammatory profile, with predominance of inflammatory status. Further studies are required to better understand the action of these drugs in HIV infection.

Feasibility of a Study on Gut Integrity, Microbial Translocation, Immune Activation and Vitamin D in People Living with HIV (PLWH) Who Use Illegal Drugs (P13-020-19)

ObjectivesThe purpose of this study was to assess the feasibility of using the Miami Adult Studies on HIV (MASH) cohort to conduct research on markers of gut integrity, MT, immune-activation and inflammation and their relationship to Vitamin D status in this cohort. We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels. MethodsNinety HIV-infected drug users and HIV-infected drug non-users were identified from the MASH cohort with IRB approval. Data for this study will be collected at baseline, 6-months and 12-months. Laboratory analyses will include: determination of Lipopolysaccharide for MT, Soluble CD14, Interleukin 6, and Tumor Necrosis Factor alpha to assess immune-activation and inflammation; 25(OH)D levels for Vitamin D status, and Intestinal Fatty Acid Binding Protein as a gut integrity marker. All laboratory analyses will be completed using plasma samples and determined by enzyme-linked immunosorbent assays in the laboratories of the MASH cohort. Dietary and anthropometric data, disease progression and medical history will be collected. The MASH cohort assesses drug use with questionnaires, urine toxicology, and cocaine metabolites. ResultsWe hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels. ConclusionsThe MASH cohort participants are well-characterized and followed longitudinally enabling access to the participants and their information. This study will provide information to develop adjunct therapies for the management of HIV, gut health and nutrition. Funding SourcesThe National Institute of Drug Abuse provides funding for the MASH cohort.

Personality traits and substance use disorders: Comparative study with drug user and non-drug user population

ObjectivePersonality traits play a vital role in addictive behaviors, drug addiction in particular. Aim of studyTo compare normal and pathological personality traits in drug users and non-drug users. MethodsIn this comparative study, we employed convenience sampling to recruit drug users (n = 110; 58 men and 52 women), from addiction treatment centers in a selected city in Azarbaijan province, and matched group of non-drug users (n = 110; 58 men and 52 women). The data were collected using demographic information questionnaire, Jakson-5 scale, Temperament and Character Cloninger (TCI), and Personality Inventory for DSM-5-Brief Form (PID-5-BF). The data were analyzed by chi square and multivariate analysis of variance (MANOVA). ResultsTwo groups were significantly different in normal (r-RST, TCI) and pathological (PID-5) personality models. In TCI model, drug users gained high scores in the dimensions of novelty seeking and harm avoidance; and obtained low scores in the dimensions of reward dependence, persistence, and self-directedness. In r-RST model, they gained high scores in r-BAS and r-fight System; and obtained low scores in r-BIS. Also, in pathological personality model (PID-5), the scores of drug users were high in all of the dimensions except for detachment dimension. ConclusionOur findings suggest that personality traits are coincidence in drug users. Professional evaluation of drug using patients in order to differentiate normal and pathological personality models of them is recommended.

Onicomicosis en pacientes con infección por el VIH y su relación con la cifra de linfocitos CD4

ObjectiveTo determine the clinical, aetiological and epidemiological features of onychomycosis in human immunodeficiency virus infected patients, and its relationship with the CD4 lymphocyte count. Materials and methodsDescriptive and prospective study in human immunodeficiency virus infected patients who attended the Hospital Regional Docente de Trujillo, a regional referral centre of the north of Peru. Pearson chi-squared and likelihood ratios were used to correlate clinical features, severity, the aetiological agent and CD4 count. ResultsThe study included a total of 51 patients, the large majority (86.3%) of them male, and with a mean age of 35 years-old. The predominant job (25.5%) was manual worker. About 74.4% stated they were non-drug users, and the most frequent sexual behaviour was heterosexual (60.8%). The onset of illness ranged from 1 to 120 months. The most common clinical presentation (60.8%) was total dystrophic onychomycosis. The most frequent (74.5%) location was the feet and 62.7% were severely compromised. The onset of human immunodeficiency virus diagnosis ranged from 1 to 96 months. Trichophyton sp. was the most found aetiological agent (52.9%). Two-thirds (66.7%) were not on antiretroviral treatment at the time of diagnosis. Viral load ranged from 80 to 1,322,930. CD4+ cell count varied between 2 and 566. A statistically significant relationship was found between clinical presentation and CD4 cell count. ConclusionThe large majority of patients were young adults, male, manual workers, non-drug users, and heterosexual. The most frequent clinical presentation was total dystrophic onychomycosis. The most commonly isolated aetiological agent was Trichophyton sp. A relationship was found between total dystrophic onychomycosis and a CD4 cell count less to 200 cell/ml.

Response to direct-acting antiviral therapy among ongoing drug users and people receiving opioid substitution therapy

People who inject drugs (PWID) and are on opioid agonist therapy (OAT) might have lower adherence to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) and, therefore, lower rates of sustained virologic response (SVR). Because of this, we compared the SVR rates to interferon-free DAA combinations in individuals receiving OAT and those not receiving OAT in a real-world setting. The HEPAVIR-DAA cohort, recruiting HIV/HCV-coinfected patients (NCT02057003), and the GEHEP-MONO cohort (NCT02333292), including HCV-monoinfected individuals, are ongoing prospective multicenter cohorts of patients receiving DAAs in clinical practice. We compared SVR 12 weeks after treatment (SVR12) in non-drug users and PWID, including those receiving or not receiving OAT. Intention-to-treat and per protocol analyses were performed. Overall, 1,752 patients started interferon-free DAA treatment. By intention-to-treat analysis, 778 (95%, 95% CI 93%-96%) never injectors, 673 (92%, 95% CI 89%-93%) PWID not on OAT and 177 (89%, 95% CI 83%-92%) PWID on OAT achieved SVR12 (p = 0.002). SVR12 rates for ongoing drug users (with or without OAT) were 68 (79%) compared with 1,548 (95%) for non-drug users (p <0.001). Among ongoing drug users, 15 (17%) were lost-to-follow-up, and 3 (3.5%) became reinfected. In the per protocol analysis, 97% never injectors, 95% PWID not on OAT and 95% PWID on OAT achieved SVR12 (p = 0.246). After adjustment, ongoing drug use was associated with SVR12 (intention-to-treat) and OAT use was not. HCV-infected PWID achieve high SVR12 rates with DAAs whether they are on OAT or not, but their response rates are lower than those of patients who never used drugs. This is mainly attributable to more frequent loss to follow-up. Accounting for active drug use during DAA therapy nearly closed the gap in SVR rates between the study groups. Patients with hepatitis C virus infection who are on opioid agonist therapy can achieve high cure rates with current treatments. The use of illicit drugs during treatment can drive drop-outs and reduce cure rates. However, hepatitis C can be cured in most of those using drugs who complete treatment and follow-up. Clinical trial number: HEPAVIR-DAA cohort, NCT02057003; GEHEP-MONO cohort, NCT02333292.

Use of illicit amphetamines is associated with long-lasting changes in hand circuitry and control

ObjectiveThe study aim was to determine if use of illicit amphetamines or ecstasy is associated with abnormal excitability of the corticomotoneuronal pathway and manipulation of novel objects with the hand. MethodsThree groups of adults aged 18–50 years were investigated: individuals with a history of illicit amphetamine use, individuals with a history of ecstasy use but minimal use of other stimulants, and non-drug users. Transcranial magnetic stimulation was delivered to the motor cortex and the electromyographic response (motor evoked potential; MEP) was recorded from a contralateral hand muscle. Participants also gripped and lifted a novel experimental object consisting of two strain gauges and an accelerometer. ResultsResting MEP amplitude was larger in the amphetamine group (6M, 6F) than the non-drug and ecstasy groups (p < 0.005) in males but not females. Overestimation of grip force during manipulation of a novel object was observed in the amphetamine group (p = 0.020) but not the ecstasy group. ConclusionsHistory of illicit amphetamine use, in particular methamphetamine, is associated with abnormal motor cortical and/or corticomotoneuronal excitability in males and abnormal manipulation of novel objects in both males and females. SignificanceAbnormal excitability and hand function is evident months to years after cessation of illicit amphetamine use.

Association between Drug Use and In-hospital Outcomes after Infrainguinal Bypass for Peripheral Arterial Occlusive Disease

Drug abuse may affect lower extremity vessels due to ischemia following intra-arterial injections, vasospasm, arterial and venous pseudoaneurysms, arteriovenous fistulae, vasculitis, and complicated abscesses. Little is known about the outcomes of lower extremity bypass (LEB) for peripheral arterial disease (PAD) in patients with a history of drug abuse disorder. The aim of this study is to evaluate the outcomes of LEB in this patient population. A retrospective study of the Premier Healthcare Database 2009-2015 was performed. In-hospital complications, mortality, and hospitalization costs were assessed in patients with a history of drug abuse disorder (opioids, cannabis, cocaine, sedatives/hypnotics/anxiolytics, and hallucinogens/methamphetamine/psychoactive drugs) who underwent LEB for PAD. Multivariable logistic and generalized linear models were utilized to study the association between drug use/misuse and in-hospital outcomes after LEB. Our cohort included 50,976 patients, of which 967 (2%) had a history of drug abuse disorder on admission. The majority of drugs were cannabis (38.5%), followed by opioids (21.5%) and cocaine (14.5%). Patients with a history of drug use/misuse were significantly at a higher risk of developing complications during their hospital stay (71.9% vs. 64.2%, P<0.001) including acute renal failure (11.8% vs. 9.1%), stroke (1.6% vs. 0.6%), respiratory complications (pneumonia and respiratory failure) (15.0% vs. 9.6%), hemorrhage/shock (36.2% vs. 31.8%), vascular or graft-related complications (29.8% vs. 26.4%), wound complications (9.1% vs. 6.3%), cellulitis (8.5% vs. 6.8%), and sepsis (2.1% vs. 1.2%, all P<0.001). In addition, drug users were found to have higher risk of concomitant major amputations compared to nondrug users (2.0% vs. 0.9%, P<0.001). On multivariable analysis, no difference was noted between the 2 groups in terms of in-hospital mortality and concomitant major amputations. However, drug use/misuse was associated with 57% higher odds of overall in-hospital complications (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.34-1.83, P<0.001), a prolonged length of hospital stay (median: 7days vs. 5days in nonabusers, P<0.001), and higher hospitalization costs compared to nonusers (adjusted mean difference: OR $3,075, 95% CI $2,096-$4,055, P<0.001). Drug use/misuse is significantly associated with increased odds of in-hospital complications, longer hospital stays, and higher hospitalization costs following LEB. Vascular surgeons need to pay special attention to this patient population and explore interventions to decrease the morbidity and economic burden associated with drug use.

Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

IntroductionGender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise. MethodsWe performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis. ResultsBoyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems, or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation. ConclusionsSome boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.

Elevated prevalence of high-risk HPV in healthy oral mucosa of users and nonusers of drugs in Northeastern Brazil.

Variable rates of HPV infection have been reported in healthy oral mucosa worldwide. The main objective of this study was to detect and genotype HPV infection in users and nonusers of drugs with clinically healthy mucosa from the Northeast Brazil. Samples from 105 patients were amplified using the primers MY09/MY11 and GP5+/GP6+, and genotyping was performed by multiplex-PCR for HPV-6/11, 16 and 18. A total of 81.9% samples were positive. Among drug users, 84.5% presented the virus and 20.4% showed multiple infections. Among non-drug users, 78.7% were positive and 13.5% had multiple infections. Limited information is available on oral HPV in Brazilian population, especially for drug users, and our results showed higher HPV infection rates in both users and nonusers of drugs. More studies and researches focused on drug users including factors like sexual behavior, nutrition and cultural habits are necessary to enhance the comprehension of this relationship, and develop preventive strategies.

The effect of the needle exchange program on the spread of some sexually transmitted diseases.

In this paper we consider a model for the spread of a sexually transmitted disease considering sexual transmission and spread via infected needles among intravenous drug users. Besides the transmission among drug users, we also consider sexual contacts between intravenous drug users and non-drug users. Furthermore, the needles are considered as a vector population. For several European countries, a sharp increase of sexually transmitted diseases was reported and several others are rated as endangered based on the number of syringes given out per intravenous drug users per year. The main purpose of the paper is to investigate the dynamics of this model including the effect of needle exchange and study the risk of an increased transmission among non-drug users, induced by the reduction of the needle exchange program. Following the determination of the basic reproduction number R0 it is shown that all solutions tend to the unique disease-free equilibrium if R0 < 1. We also prove that the disease persists in the human population if R0 > 1. Our numerical simulations, based on real life and hypothetical data for HIV, suggest that a decrease in the rate of the distribution and discharge rate of new needles might imply that the considered disease is becoming endemic in the considered human population of drug users and non-drug users. A variant of our model with time- variable needle distribition parameter is fitted to recent HIV data from Hungary to give a forecast for the number of infected in the following years.