Reuse Of Needles Research Articles

Impact of Syringe and Needle Reuse on the Clinical Outcomes of Patients With Type 2 Diabetes: A 12-Week Randomized Clinical Trial.

To evaluate the clinical and laboratory outcomes of patients with type 2 diabetes by comparing the no reuse or reuse of syringes and needles for insulin injection. Adults with type 2 diabetes who had reused syringes and needles at least three times were randomly instructed either to not reuse or to reuse insulin syringes and needles five times. The primary outcomes assessed were glycemic control, pain scores, and skin complications (ecchymosis, lipohypertrophy, nodules, infection) at baseline and 4, 8, and 12 weeks after the intervention. Secondary outcomes included treatment adherence, quality of life, microbiological contamination of syringes and needles, needle quality, and insulin injection technique. Among the 71 participants (mean ± SD age 59.7 ± 8.8 years), 59% were women with a median duration of diabetes of 18 years (interquartile range 10-25 years) and a mean BMI of 31.7 ± 6.7 kg/m2. The group that reused syringes and needles experienced an increase in lipohypertrophy/nodules (0.16 ± 0.08, P = 0.040) but did not experience worsening pain or glycemic control, even when the syringes and needles were inserted into the skin with great effort. There was no difference in the total number of skin complications, quality of life, or microbiological contamination. Both groups improved treatment adherence, with a greater increase in the reuse group. The reuse of syringes and needles is associated with a modest increase in lipohypertrophy/nodules but does not have a short-term impact on glycemic control in patients with type 2 diabetes.

Prevalence and risk factors for hepatitis C virus infection in an informal settlement in Karachi, Pakistan.

The burden of hepatitis C virus (HCV) infection in Pakistan is amongst the highest in the world. People living in slums are likely to be at high risk of infection. Here, we describe the results of a cross-sectional survey conducted in March 2022 that aimed to quantify the prevalence of HCV infection in Machar Colony, one of the largest and oldest slum settlements in Karachi. Risk factors for HCV seropositivity were identified using multi-level logistic regression. We recruited 1,303 individuals in a random selection of 441 households from Machar Colony. The survey-adjusted HCV-seroprevalence was 13.5% (95% Confidence Interval (CI) 11.1-15.8) and survey-adjusted viraemic prevalence was 4.1% (95% CI 3.1-5.4) with a viraemic ratio of 32% (95% CI 24.3-40.5). Of 162 seropositive people, 71 (44%) reported receiving previous treatment for chronic hepatitis C. The odds of HCV seropositivity were found to increase with each additional reported therapeutic injection in the past 12 months (OR = 1.07 (95% Credible Interval (CrI) 1.00-1.13)). We found weaker evidence for a positive association between HCV seropositivity and a reported history of receiving a blood transfusion (OR = 1.72 (95% CrI 0.90-3.21)). The seroprevalence was more than double the previously reported seroprevalence in Sindh Province. The overall proportion of seropositive people that were viraemic was lower than expected. This may reflect the long-term impacts of a non-governmental clinic providing free of cost and easily accessible hepatitis C diagnosis and treatment to the population since 2015. Reuse of needles and syringes is likely to be an important driver of HCV transmission in this setting. Future public health interventions should address the expected risks associated with iatrogenic HCV transmission in this community.

Impacts of COVID-19 on sexual risk behaviors, safe injection practices, and access to HIV services among key populations in Zambia: Findings from a rapid qualitative formative assessment.

Despite achievements in the HIV response, social and structural barriers impede access to HIV services for key populations (KP) including men who have sex with men (MSM), transgender women (TGW), and people who inject drugs (PWID). This may be worsened by the COVID-19 pandemic or future pandemic threats. We explored the impact of COVID-19 on HIV services and sexual and substance use behaviors among MSM/TGW and PWID in Zambia as part of a formative assessment for two biobehavioral surveys. From November-December 2020, 3 focus groups and 15 in-depth interviews (IDIs) with KP were conducted in Lusaka, Livingstone, Ndola, Solwezi, and Kitwe, Zambia. Overall, 45 PWID and 60 MSM/TGW participated in IDIs and 70 PWID and 89 MSM/TGW participated in focus groups. Qualitative data were analyzed using framework matrices according to deductive themes outlined in interview guides. KP reported barriers to HIV testing and HIV treatment due to COVID-19-related disruptions and fear of SARS-CoV-2 exposure at the health facility. MSM/TGW participants reported limited supply of condoms and lubricants at health facilities; limited access to condoms led to increased engagements in condomless sex. Restrictions in movement and closure of meet-up spots due to COVID-19 impeded opportunities to meet sex partners for MSM/TGW and clients for those who sold sex. COVID-19 restrictions led to unemployment and loss of income as well as to shortages and increased price of drugs, needles, and syringes for PWID. Due to COVID-19 economic effects, PWID reported increased needle-sharing and re-use of needles. Participants experienced barriers accessing HIV services due to COVID-19 and PWID attributed unsafe needle use and sharing to loss of income and lack of affordable needles during pandemic-related restrictions. To maintain gains in the HIV response in this context, strengthening harm reduction strategies and improvements in access to HIV services are necessary.

Insulin-induced lipodystrophy and predisposing factors in children and adolescents with type 1 diabetes mellitus (T1DM) in a tertiary care Egyptian center.

Lipodystrophy (LH) is one of the most common complications of subcutaneous insulin injection. Many factors are incriminated in the evolution of LH in children with diabetes type 1 (T1DM). LH may affect insulin absorption in the skin areas involved, resulting in a negative impact on blood glucose levels and glycemic variability. We calculated and evaluated the prevalence of LH in relation to possible clinical factors associated with the development of LH in a cohort of children (n =115) with T1DM using insulin pens or syringes and we studied possible predisposing factors including their age, duration of T1DM, injection technique, insulin dose/kg, degree of pain perception, and HbA1c level. In our cross-sectional study, 84% of patients were using pens for insulin injection and 52.2 % of them were rotating the site of injection on daily basis. 27 % did not experience pain during an injection while 6 % had the worst hurt. 49.5 % had clinically detectable LH. Those with LH had higher HbA1c levels and more unexplained hypoglycemic events compared to those without LH (P: 0.058). The hypertrophied site was related to the preferred site of injection which was the arms in 71.9 % of the cases. Children who had LH were older with a longer duration of T1DM, rotating sites of injection less frequently, and were more frequently reusing needles compared to children without LH (P: < 0.05). Improper insulin injection technique, older age, and longer duration of T1DM were associated with LH. Proper education of patients and their parents must include correct injection techniques, rotating injection sites, and minimal reuse of needles.

Assessing Reuse of Hypodermic Needles in Mice by means of Digital Imaging, Photomicrography, Bacterial Culture, Analysis of Nest Building, and Animal Vocalization.

Hypodermic needles are sometimes reused in animal research settings to preserve the viability of and to conserve limited quantities of injected material. However, the reuse of needles is strongly discouraged in human medicine to prevent inju- ries and the spread of infectious disease. No official guidelines prohibit needle reuse in veterinary medicine, although the practice may be discouraged. We hypothesized that reused needles would be significantly more blunt than unused needles and that reuse for additional injections would cause more animal stress. To test these ideas, we evaluated mice that were injected subcutaneously in the flank or mammary fat pad to generate cell line xenograft and mouse allograft models. Needles were reused up to 20 times, based on an IACUC-approved protocol. A subset of reused needles was digitally imaged to determine needle dullness based on the area of deformation from the secondary bevel angle; this parameter was not different between new needles and needles that had been reused 20 times. In addition, the number of times a needle was reused was not significantly related to audible mouse vocalization during injection. Finally, nest building scores for mice that were injected with a needle used 0 through 5 times were similar to those of mice injected with a needle had been used 16 through 20 times. Among the 37 reused needles that were tested, 4 were positive for bacterial growth; the only organisms cultured were Staphylococcus spp. Contrary to our hypothesis, reusing needles for subcutaneous injections did not increase animal stress based on analysis of vocalization or nest building.

Challenges Faced and Coping Strategies Adopted by Injecting Drug Users during COVID-19 Lockdown-A Qualitative Study.

The lockdown due to COVID-19 pandemic has adversely affected the lives of vulnerable population, including the injecting drug users (IDUs). The objective of the study was to document the coping mechanism adopted by IDUs and suggest measures to mitigate the adverse effects, if similar situation were to arise in future. A qualitative study was conducted at the Targeted Intervention Non-Government Organizations catering to IDUs in Delhi and Ghaziabad district of Uttar Pradesh. Four focus group discussions among 41 IDUs and 7 key informant interviews of the NGO staff were conducted in the study. The Hindi recordings were coded and the data analysis was performed manually using grounded theory approach. We found that the lockdown affected the lives of most of the IDUs and they found it difficult to access the harm reduction services. To cope with this, many IDUs started following alternate methods to support the drug habits. There was an increase in reuse of needles and syringes. The lockdown during COVID-19 and the resulting challenges negatively impacted the physical and mental health of the IDUs. We recommend that in any similar future scenario, travel pass may be issued to the IDUs and the TI-NGO personnel.

Risk factors associated with enzootic bovine leukosis in Boyacá and Cundinamarca municipalities, Colombia.

Enzootic bovine leukosis (EBL) is a lymphoproliferative disorder caused by the bovine leukemia virus (BLV), a virus of the Retroviridae family. The infection is distributed worldwide, and a high percentage of animals infected by the BLV are asymptomatic and act as carriers of the virus in many cattle populations. To identify the risk factors associated with EBL in the municipalities of Boyacá and Cundinamarca (Colombia). A simple descriptive cross-sectional study with random sampling was conducted. A total of 1,140 blood samples were taken from cattle (females and males) from the municipalities of Chiquinquirá, Ubaté, and San Miguel de Sema of different breeds and age groups. The samples were processed using the commercial ELISA SERELISA® BLV Ab Mono Blocking kit (sensitivity 97%, specificity 98%). The data were processed with the statistical programs WinEpi and Epi Info® version 7.2.4.0, estimating the prevalence ratio, implementing the chi-square test (p ≤ 0.05) and logistic regression. A true prevalence (TP) and apparent prevalence (AP) of 23.61% and 22.7% in Ubaté, 19.22% and 18.1% in Chiquinquirá, and 15.61% and 14.3% in San Miguel de Sema, respectively, were established. Bovines 2-4 years old were the most prevalent in Ubaté and Chiquinquirá (37.5% and 21.21%, respectively), while in San Miguel de Sema individuals >4 years had the highest percentage of antibodies (18.3%). The Holstein breed had a higher prevalence in Ubaté and San Miguel de Sema (26.02% and 19.67%), and crossbreeds were more BLV-seroprevalence in Chiquinquirá (20.20%). In Ubaté, re-use of needles was identified as a risk factor, contaminated blood in needles is considered one of the main routes of transmission. On the other hand, manual milking was identified as a risk factor in San Miguel de Sema. The non-implementation of an individual needle per animal in Ubaté; the Holstein breed and manual milking in San Miguel de Sema were identified as risk factors for the presence of antibodies against the disease. EBL prevention and control plans should be established that focus on the implementation of management and sanitary practices based on herd biosecurity.

Addendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India.

With the emerging complexities in chronic diseases and people's lifestyles, healthcare professionals (HCPs) need to update their methods to manage and educate patients with chronic lifestyle disorders, particularly diabetes. The insulin injection technique (IIT), along with various parameters, must also be updated with newer methods. Forum for Injection Technique and Therapy Expert Recommendations (FITTER), India, has updated its recommendations to cover newer ways of detecting hypoglycaemia and lipohypertrophy, preventing needlestick injuries (NSIs), discouraging the reuse of insulin needles and encouraging good disposal. FITTER, India, is also introducing recommendations to calculate insulin bolus dose. These updated recommendations will help HCPs better manage patients with diabetes and achieve improved outcomes.

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS HEPATITIS C AMONG CLINICAL MEDICAL STUDENTS OF CHUKWUEMEKA ODIMEGWU OJUKWU UNIVERSITY (COOU), AMAKU, AWKA, ANAMBRA STATE

Presently, there are so many viral diseases flying across the globe, of which hepatitis, a disease of the liver is one of them. This disease is caused by various strains of the hepatitis virus (A, B, C, D and E). Hepatitis C virus is a highly contagious virus that is majorly responsible for chronic liver disease across the globe. HCV infection is a blood-borne infection that is transmitted through contact with infected blood by reuse or insufficient sterilization of needles or sharp objects, transfusion of unscreened blood, sharing injection materials by drug users and perinatal transmission (mother to child). HCV infection prevalence is high in sub-Saharan region, where it is the cause of hundreds of thousands of deaths annually. Medical students, a great population of the health workers, are at most risk of the infection because they are mostly the first direct contact of patients in a healthcare facility. And so, there is need for them to be well aware of the viral infection and its mode of transmission. This study is aimed at assessing the knowledge, attitude, and practice towards the infection as this will help curtail transmission of the virus. 147 clinical medical students were sampled for the purpose of this study using a 31-item self-administered questionnaire to extract the necessary information. SPSS 28.0 was used for data entry and analysis, alongside Chi-square test that evaluated the connection between variables, a p-value of less than 0.05 was regarded as statistically significant. The result showed that in practice, 20.5% of respondents avoid HCV patients, and 15.6% do not wear gloves when attending to patients. For vaccination, 27.4% of the respondents were not immunized against the virus. The study found a strong correlation between students' ages and their mean Knowledge, Attitude, and Practice scores (p-value=0.014). This study revealed that 46% of respondents believed that people with hepatitis C should be quarantined. This unfavorable attitude may increase stigmatization of people with hepatitis C in society. Sadly, our survey reveals that 63.7% of respondents had no clue about the protocols that should be followed after a needle injury. This is a dangerous finding because each clinical student should be familiar with these protocols in order to reduce the risk of contracting an infection. In conclusion, there is a very important and urgent need to increase sensitization among clinical medical students as a whole lot of them have poor practice and attitude towards the virus. Keyword : Hepatitis C Virus, Clinical Medical Students, Anambra State DOI: 10.7176/JMPB/72-09 Publication date: November 30 th 2022

A Large Data Set; Hepatitis B and C Infection in Pregnant Females

Background: Hepatitis B and C virus (HBV &amp; HCV) infection is on the surge among pregnant women as a result of unsaved dental and cosmetic procedures, reuse of needles, raising the risk of perinatal transmission and HBV &amp; HCV infection in children. Although few studies on the prevalence of HBV and HCV infection during pregnancy have been conducted but the majority of the studies are on very low sample size. The current study is based on large data set. Objectives: The major goal of this study was to find out the frequency of HBV &amp; HCV in pregnant women. Methods: We conducted a retrospective cohort study in Alkhidmat Raazi Hospital Rawalpindi. A total of 31911 pregnant women who delivered between 2016 and 2021 were analyzed and categorized as HBV &amp; HCV infected or HBV &amp; HCV uninfected by billing codes. The birth certificate and hospital discharge records were used to identify infant records related to HBV and HCV-infected pregnant mothers. Pregnant women's plasma samples were tested for HBV and HCV using chemiluminescence ARCHITECT i1000SR® Abbott Diagnostics. Data were analyzed using packages within SPSS software and P ≤ 0.05 was considered significant. Cross-tabulation chi-square analysis was performed with a significance level of 5%. Results: The pregnant women with age under 25 years were 12699 (39.8%), women with age from 26 to 29 years were 9734 (30.5%), while women with age 30 and older were 9478 (29.7). The patients who were primigravida were 9514 (29.8%), multipara having 1-4 children 18545 (58.1%) and those having more than five children were 3852 (12.1%). The prevalence of HBV and HCV in 31911 pregnant women were 170/31911 (0.5%) and 478/31911 (1.5%), respectively. The mean age was 27.9 years. Conclusions: HBV and HCV infection is present in pregnant females, which may ultimately increase the treatment cost and vertical transmission. Keywords: Hepatitis B, Hepatitis C, Infection, Pregnant females

Anaemia in Lambs Caused by Mycoplasma ovis: Global and Australian Perspectives.

Simple SummaryMycoplasma ovis (formerly Eperythrozoon ovis) inhabits red blood cells and may cause their destruction, leading to anaemia, jaundice and death mainly in lambs, and condemnation of jaundiced carcases at abattoirs. Mycoplasmosis is spread during high-risk procedures that expose or share blood, especially when blood sucking flies and other insects are present on wounds that transfer infection. High-risk procedures include vaccination (re-use of needles), ear-tagging (ineffective disinfection), surgical castration and mulesing (in Australia), and potentially crutching and shearing, with outbreaks usually occurring up to 6 weeks later. Affected animals are weak, lagging in the ‘tail of the mob’ and collapsing when mustered. The investigation of other causes of anaemia and jaundice is required, particularly haemonchosis (Barbers pole worms) and malnutrition. The diagnosis involves the demonstration of M. ovis in blood smears and/or by PCR, although the absence of the parasite in smears from affected animals requires the examination of in-contact healthy animals. Treatment with antibiotics is ineffective. For its control, it is required that risky procedures are avoided during high insect activity and the yarding of stock within the next 6 weeks is minimised. Recent anecdotal observations suggest that improved farm practices, including fly control and pain/antiseptic wound dressing may potentially decrease M. ovis risk on some farms in some areas of Australia.Mycoplasma ovis (formerly Eperythrozoon ovis) is a haemotropic parasitic bacterium found within erythrocytes and distributed widely in global sheep and goat production regions. M. ovis is transmitted by biting flies and by contaminated instruments, causing morbidity and mortalities from anaemia, usually within 6 weeks following blood-exposure procedures, particularly vaccination, castration, ear tagging, mulesing, and occasionally crutching and shearing. Affected animals develop haemolytic anaemia and may have jaundice, causing abattoir condemnations. The typical history, clinical and pathological findings, display of M. ovis in blood smears and/or by PCR is diagnostic, although immune responses deplete M. ovis from smears; hence, in-contact healthy animals should be examined. Differential diagnoses include haemonchosis, fasciolosis, malnutrition (copper or vitamin B12 deficiency), and plant toxicities. M. ovis parasitaemia may persist, with recrudescence following stressful events, although most older sheep remain immune. Human infections have been reported. Inadequate socioeconomic data present difficulties in assessing the impact of M. ovis on production and as antimicrobial therapy is ineffective, its control requires management practices that minimize the impact of invasive procedures in periods when risks of M. ovis transmission are more likely. Although considered an emerging pathogen, recent improvements in welfare attitudes and husbandry practices on Australian sheep farms may potentially limit the transmission of M. ovis.

A Needle-Free Jet Injection System for Controlled Release and Repeated Biopharmaceutical Delivery.

Swift vaccination is necessary as a response to disease outbreaks and pandemics; otherwise, the species under attack is at risk of a high fatality rate or even mass extinction. Statistics suggest that at least 16 billion injections are administered worldwide every year. Such a high rate of needle/syringe injection administration worldwide is alarming due to the risk of needle-stick injuries, disease spread due to cross-contamination and the reuse of needles, and the misuse of needles. In addition, there are production, handling, and disposal costs. Needle phobia is an additional issue faced by many recipients of injections with needles. In addition to a detailed literature review highlighting the need for needle-free injection systems, a compressed air-driven needle-free jet injection system with a hydro-pneumatic mechanism was designed and developed by employing an axiomatic design approach. The proposed injection system has higher flexibility, uninterrupted force generation, and provides the possibility of delivering repeated injections at different tissue depths from the dermis to the muscle (depending on the drug delivery requirements) by controlling the inlet compressed air pressure. The designed needle-free jet injector consists of two primary circuits: the pneumatic and the hydraulic circuit. The pneumatic circuit is responsible for driving, pressurizing, and repeatability. The hydraulic circuit precisely injects and contains the liquid jet, allowing us to control the volume of the liquid jet at elevated pressure by offering flexibility in the dose volume per injection. Finally, in this paper we report on the successful design and working model of an air-driven needle-free jet injector for 0.2–0.5 mL drug delivery by ex vivo experimental validation.

Early detection of cutaneous complications of insulin therapy in type 1 and type 2 diabetes mellitus

BackgroundSubcutaneous insulin therapy is associated with important injection site complications, which can influence insulin pharmacokinetics resulting in glycemic fluctuations above and below target levels for blood glucose. ObjectiveOur objective was to assess the prevalence and risk factors of cutaneous complications including insulin derived amyloidosis in insulin-injecting diabetes patients and to study the role of ultrasonography (in comparison to gel-assisted palpation) in early diagnosis of lipohypertrophy (LH). MethodsThis was a cross-sectional study conducted at a tertiary care center in India, wherein 500 patients injecting insulin for ≥2 years were randomly enrolled and evaluated for the presence of cutaneous complications of insulin therapy through clinical examination, ultrasonography and punch biopsy of skin. ResultsClinical examination detected LH in 44.6% of patients. Ultrasonography diagnosed additional 13.4% of patients with LH which were missed on clinical examination. Incorrect rotation of sites (P < 0.001) and insulin syringe reusage for more than five times (P < 0.001) significantly increased the risk of LH. Skin biopsy was performed in 100 cases, out of which two patients showed apple green birefringence and its association with insulin was confirmed by positive staining with anti insulin antibody in these two patients. ConclusionImproper rotation of sites and reuse of needles were the leading causes of LH in Indian diabetic patients. Ultrasonography is more objective and reliable method of detecting LH. Insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought.

Seroprevalence and Influence of Bovine Leukemia Virus on the Incidence of Mastitis in Dairy Herds

Background: The enzootic bovine leukosis (EBL) is a viral disease with a chronic aspect and its etiological agent is an oncogenic deltaretrovirus called bovine leukemia virus (VLB). It has a wide distribution in dairy cattle herds, and it may take several years before the first clinical manifestations occur. Animals seropositive for VLB are more susceptible to developing infectious diseases such as mastitis. The objective of this study was to evaluate the seroprevalence of EBL, the prevalence of mastitis, the possible association between leukosis and mastitis, and the risk factors related to leukosis in municipalities of the Caparaó region of Espírito Santo, Brazil.Materials, Methods &amp; Results: The prevalence of enzootic bovine leukosis and its association with mastitis were evaluated in an 854 clinically healthy crossbred (Bos tauros tauros x Bos taurus indicus) dairy cows were used, in different lactation phases, from farms located in the 12 municipalities that compose the Caparaó Capixaba micro-region, in the southern part of Espírito Santo, Brazil, in the period from February to July 2015. The seroprevalence of EBL was determined by the agar gel immunodiffusion test, the presence of clinical mastitis was ascertained by the black background mug test and of subclinical mastitis by the CMT. The reuse of needles, type of milking, reproductive management, calf mortality, presence of reproductive problems and milk yield were the risk factors assessed. The association between the variables was estimated by the odds ratio (95% confidence interval). The significance of the associations was determined by the Chi-square test. The prevalence of EBL, clinical and subclinical mastitis was 56.79%, 5.50% and 43.55%, respectively. There was a positive association between the EBL virus and the presence of subclinical mastitis (P &lt; 0.05, OR = 1.41, CI = 1.07-1.86). The reuse of disposable needles (OR = 1.92, CI = 1.46-2.53), mechanical milking (OR = 2.03, CI = 1.34-3.08), calf mortality (OR = 2.39; CI = 1.25-4.55) and the presence of reproductive problems (OR = 1.62; CI = 1.23-2.14) were considered risk factors associated with LEB (P &lt; 0.05).Discussion: Enzootic bovine leukosis is disseminated in the dairy herds in the municipalities the study. The lack of knowledge about EBL among farmers and the failure to adopt measures for its control and elimination favor the appearance of new cases in the herd. Factors such as animal age, absence of exams when purchasing animals, reuse of gloves for rectal palpation and needles, contribute to dissemination of the infection. The economic losses associated with subclinical mastitis can even be greater than those caused by clinical mastitis. The differences for prevalence of clinical mastitis can be associated with the breeding system, type of management, intensification and level of production. In this context, we noted a much larger number of animals with subclinical infection, where the losses may not be perceptible to the farmers. It is concluded that EBL is widespread in dairy herds of the municipalities of Caparaó Espírito Santo's region. The prevalence of clinical and subclinical mastitis is high in some cities surveyed. The presence of EBL increases the chances of developing subclinical mastitis. The reuse of disposable needles and mechanical milking were considered risk factors associated with EBL. Seroreagent animals for EBL are more likely to present calf mortality and reproductive problems. It is necessary to discuss the best sanitary management system for the region, with a better economic and social response and then carry out the elaboration of educational and implementation measures, through technical assistance.

Procedural Pain in Hospitalized Children in a Chinese Children's Hospital

BackgroundPain prevalence in pediatric hospitals has been investigated in many developed countries, but little is known about this topic in China. AimsThis study sought to describe the frequency and pain intensity of procedures for medical care in hospitalized children in a Chinese children’s hospital. DesignA cross-sectional study was designed to include interviews with children, their parents and the nurses. SettingsThis survey was administered in a teaching hospital in southeast China. Participants/SubjectsInfants and children up to 16 years old who were admitted to the study units for more than 6 days were eligible for inclusion. MethodsInformation regarding patient demographics, painful procedures and pain management strategies was obtained during the day shifts of the children’s hospitalization. ResultsA total of 3886 procedures were performed on 342 children during the data collection period. The reuse of intravenous indwelling needles ( n = 577), removal of tape from the skin (n = 420) and venipuncture on the back of the hand ( n = 401) were the most frequently performed procedures on children. A total of 1941 procedures, accounting for 49.9% (1941/3886) of painful procedures caused moderate to severe pain (pain score ≥4.0). However, only 25.3% (984/3886) received a valid pain assessment, and only 14.4% (560/3886) received pain interventions. ConclusionsMost children, especially those who are younger (<4 years old), experienced moderate or severe pain during their hospitalization, but did not receive appropriate interventions.

Variation of the Penetration Effort in an Artificial Tissue by Hypodermic Needles.

Fear of injection-related pain is a drawback to injectable therapy. Hypodermic injections are a cause for great anxiety and reduced adherence to the subcutaneous application of insulin for glycemic control in diabetics or in the treatment of multiple sclerosis, increasing the risk of complications and mortality. Injured or sick people have to undergo several daily injections, forcing them to rotate the veins and regions used to recover from the trauma caused by the perforation of the skin, tissue, muscles, veins, and arteries. People who suffer from type 1 diabetes mellitus (DM1) need to have their glycemic control 3 to 5 times a day and to take insulin up to 3 times a day. In both cases, the patient needs to perforate the skin. To quantify the pain perceived by the patients depends on the evaluation of each patient and therefore is subjective. This study aims to understand the application and self-application of hypodermic injections and decrease pain during its application and the phobia of the patient, following the reasoning that the lower the effort to penetrate the needle, the less trauma in the tissue and therefore the pain provoked. For that, it was analyzed how some of the characteristics of the needle can influence the sensation of pain in the injection. The needle penetration effort was measured in an artificial tissue (substitute skin model) for different cannula diameters, roughness, depth of penetration, lubrication, and angles of the perforating tip bevel. This study aimed to find alternatives to facilitate the application and self-application of hypodermic injections, increase safety and comfort, and reduce the pain intensity perceived by the patient. To do this, the bevel of needles used repeatedly was analyzed in the profile projector and SEM to verify the loss of the profile or the formation of burrs that could hamper the penetration or traumatize the tissue during the reuse of needles. It has also been mechanically analyzed, which can be done to prevent that the needles used in the subcutaneous application do not inadvertently reach the muscle. The greater penetration effort observed in the needles with greater angle of the bevel is responsible for the patient's perception of pain.

Profile and correlates of injecting-related injuries and diseases among people who inject drugs in Australia

IntroductionPeople who inject drugs (PWID) commonly experience harms related to their injecting, many of which are consequences of modifiable drug use practices. There is currently a gap in our understanding of how certain injecting-related injuries and diseases (IRID) cluster together, and socio-demographic and drug use characteristics associated with more complex clinical profiles. MethodSurveys were conducted with 902 Australian PWID in 2019. Participants provided information regarding their drug use, and past month experience of the following IRID: artery injection, nerve damage, skin and soft tissue infection, thrombophlebitis, deep vein thrombosis, endocarditis, septic arthritis, osteomyelitis, and septicaemia. We performed a latent class analysis, grouping participants based on reported IRID and ran a class-weighted regression analysis to determine variables associated with class-membership. ResultsOne-third (34 %) of the sample reported any IRID. A 3-class model identified: 1) no IRID (73 %), moderate IRID (21 %), and 3) high IRID (6%) clusters. Re-using one`s own needles was associated with belonging to the high IRID versus moderate IRID class (ARRR = 2.38; 95 % CI = 1.04−5.48). Other factors, including daily injecting and past 6-month mental health problems were associated with belonging to moderate and high IRID classes versus no IRID class. ConclusionA meaningful proportion of PWID reported highly complex IRID presentations distinguished by the presence of thrombophlebitis and associated with greater re-use of needles. Increasing needle and syringe coverage remains critical in addressing the harms associated with injecting drug use and expanding the capacity of low-threshold services to address less severe presentations might aid in reducing IRID amongst PWID.

Hepatitis C virus genotypes and associated risk factors in the state of Pará, Northern Brazil

BackgroundDespite the emergence of more effective therapies, hepatitis C virus (HCV) infection remains a serious public health problem at the global level. Currently, this virus is classified into seven genotypes and 67 subgenotypes, which in turn are distributed heterogeneously in Brazil and worldwide. Studies have shown that this genetic divergence results in differences in the progression of chronic disease associated with HCV infection and its treatment. ObjectiveThe aim of this study was to report the frequency of HCV genotypes in the state of Pará, Northern Brazil, and to assess the association between genotype and different clinical and laboratory characteristics, as well as risk factors for infection. MethodData from 85 medical records of untreated patients who had chronic hepatitis C infection were analyzed; the patients were evaluated at two hospitals in Belem, Pará, Brazil. ResultsCirculation of genotypes 1 and 3 was detected, with a higher prevalence of genotype 1 (75.3%) than genotype 3 (24.7%). In addition, there was a predominance of subgenotype 1b (60.34%) compared to 1a (20.69%) and 3a (18.97%). Reuse of needles and/or glass syringes was significantly associated with infection by HCV genotype 1 than genotype 3; however, the small number of patients infected with genotype 3 may have biased the results. No associations between genotype and the evaluated clinical and laboratory characteristics were observed. ConclusionThis study reinforces the differences in the distribution of HCV genotypes in Brazil and showed no association between HCV genotype and progression of chronic hepatitis C in the studied group.

SAT-672 An Unusual and Enigmatic Etiology for Diabetic Ketoacidosis: Safety Needles

Diabetic ketoacidosis is associated with a mortality rate of upto 6.1% and accounts for an estimated 115000 hospital discharges per year in the United States. In order to reduce mortality related to DKA, precipitating causes must be identified and addressed. The most common precipitant for DKA is infection with other precipitating factors including acute illness, medications and inadequate insulin therapy (1).A 76 year-old woman with type 2 diabetes was transferred from her assisted living facility for hyperglycemia. This was her fifth admission in the last month and a half attributed to either hyperglycemia or DKA. Her medications included insulin glargine and insulin aspart. She mentioned compliance with her insulin as well as her diabetic diet. In the ER, her vitals were stable with physical examination showing an obese woman in no acute distress. Her labs showed a blood glucose of 780, an anion gap of 17 and positive serum ketones. Further investigation did not reveal a source of infection or ischemia. The patient was treated in the ICU with intravenous insulin and fluids with resolution of her ketoacidosis. The patient was discharged with a 67% increase in her prandial insulin. On further review, her facility had recently required safety needles to be used for insulin pens. Patient was asked to demonstrate her technique with observation that patient was not pushing down enough to allow for the needle to enter her skin with subsequent trapping of her insulin within the needle. Prior to discharge, she was educated on proper administration of her insulin and since her discharge, she has had no subsequent readmissions for hyperglycemia.Hospitals and long-term facilities are the primary utilizers of needles with a retractable safety shield. Reduction of accidental puncture, elimination of reuse of needles and helping patients overcome anxiety about needles are some of the key advantages of these needles. Upon application of pressure onto the skin, the automatic shield or plastic cannula retracts and thus hides the needle before, during and after the injection. The major disadvantage is insulin being deployed while the needle is outside the body if incorrectly applied. Therefore, appropriate administration must be taught to the patient, including perpendicular insertion of the needle into the subcutaneous tissue and ensuring a more firm surface by injecting into a lifted skin fold. Legislation in the US has been passed requiring safety-engineered devices when feasible.In situations where the safety-engineered devices can impair effectiveness or cause harm, alternative approaches can be utilized, including insulin syringes or self-administration of insulin along with safe work procedures (1).1. Yu Catherine H.Y.. “Safety” technology: a hidden cause of diabetic ketoacidosis. Canadian Medical Journal Journal. 2012 Mar 20;184(5):557–558.

Injection practices among the diabetes patients on insulin therapy in Chitradurga

Background: Diabetes mellitus has emerged as a global health problem. Insulin is the essential treatment modality for significant number of diabetic patients. Nearly 4 out of 10 patients with T2DM in India are using insulin, either alone or in combination with oral hypoglycemic drugs (OADs). The present study was conducted with the objectives to assess the knowledge and insulin injection practices, risk factors of sharps injury among diabetic patients who are on insulin treatment.Methods: Cross sectional study was conducted at a Basaveshwara hospital, Chitradurga, among diabetic patients on insulin treatment for minimum of past 6 months. Insulin injection technique questionnaire (ITQ) was administered to study participants and proforma was filled by interview technique.Results: 100 patients participated in the study. Syringe and needle device and 6 mm needle are most commonly used devices. 5-10 seconds was the most common duration of time (54%) for which the patients continued to keep the needle inserted in injection site after insulin injection. A 26% patients had lip hypertrophy at injection sites. Among households of the insulin users, a high percentage of children (41%) and house keeper/waste collectors (32%) were at risk of sharps injury. A majority of 55% of the insulin users reported that they didn’t have appropriate disposal containers for the used sharps.Conclusions: A 29% of participants did not practice proper rotation of injection site. Reuse of insulin needles was common practice. Pain/tenderness, lipo-hypertrophy and leakage of insulin after injection were noted at injection site. 10 seconds dwell time was reportedly practiced by only 23%, about half of patients skipped insulin injections and didn’t follow appropriate disposal of used sharps, thereby exposing both family members and waste collectors/handlers to higher risks of sharps injuries.