Sterile Syringes Research Articles

Expansion of Syringe Service Programs in the United States, 2015-2018.

Objectives. To report on the expansion of syringe service programs (SSPs) in the United States from 2015 to 2018.Methods. We obtained data from records of the Buyers' Club of the Dave Purchase Project/North American Syringe Exchange Network (NASEN), including the number of US SSPs and the numbers of sterile syringes purchased by programs. We conducted a subset analysis of states with high numbers of counties defined as "vulnerable" by the Centers for Disease Control and Prevention.Results. SSP participation in the Buyers' Club increased from 141 in 2015 to 292 in 2018, with an increase in syringes purchased from 42 million to 88 million. In addition to these large increases in numbers of programs and in syringes purchased, there were also indications of instability among new programs in vulnerable states.Conclusions. There have been substantial increases in the number of programs established and the number of syringes distributed in response to the opioid epidemic. Ensuring high-quality services in these new programs will be critical to successfully addressing the current epidemic.

Self-made negative pressure drainage device by sterile infusion set and syringes

Negative pressure drainage (NPD), which can prevent infection, reduce dead space, and accelerate wound healing, is indispensable in the treatment of wounds with a large dead space.1 However, commercial NPD devices are expensive and less available in less developed areas.

Availability, Accessibility, and Coverage of Needle and Syringe Programs in Prisons in the European Union.

Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.

Seroprevalence and risk factors of avian reovirus in backyard chickens in different areas of Mymensingh district in Bangladesh.

Objective:The present study estimated the seroprevalence of avian reovirus (ARV) infections in backyard chickens of the Mymensingh district in Bangladesh.Materials and Methods:Considering several risk factors, a total of 460 serum samples were collected from backyard chickens from eight Upazilas of the Mymensingh district in Bangladesh. Blood samples were taken from the wing vein using 3-ml sterile syringes and kept at room temperature for clotting in a slanting position and then transported to the laboratory maintaining the cool chain. Subsequently, the prepared sera were harvested and stored at −20°C until used. Finally, an indirect enzyme-linked immunosorbent assay (ELISA) was performed to detect ARVspecific antibodies using a commercial ARV antibody detection ELISA test kit.Results:The results revealed high prevalence rates of ARV antibodies, with a total seroprevalence of 69.78% (321/460). Area-wise, 74.55% (82/110) seroprevalence was recorded as the highest in Mymensingh Sadar, whereas 64% (32/50) was the lowest in Gauripur Upazila. With regard to sex, female chickens showed a significantly higher (p < 0.05) seroprevalence as 90.33% (271/300) compared to male chickens 31.25% (50/160). With regard to age groups, the seroprevalence of ARV infection was 59.33% (89/150) within 2–8 weeks, 82% (205/250) within 9–16 weeks, and 45% (27/60) within 17–20 weeks, respectively. Based on hygienic conditions, the highest seroprevalence of ARV was noted in backyard chickens housed in poor conditions 80% (120/150) than good conditions 50% (40/80). Backyard chickens reared in free-ranging conditions exhibited a significantly higher seroprevalence 73.33% (220/300) of ARV antibodies compared to rearing in separate houses 63.12% (101/160). The seroprevalence of ARV was higher in crossbreeds 71.67% (43/60), brought from market 76% (38/50), and unhealthy 78.57% (55/70) backyard chickens than non-descriptive indigenous 69.5% (278/400), home-reared 69.02% (283/410), and healthy chickens 68.21% (266/390).Conclusion:The high prevalence of ARV antibodies revealed in the current study indicates an extensive exposure of ARV to backyard chickens in Bangladesh that may be transmitted naturally to other chickens, ultimately leading to ominous economic effects on the poultry sector.

САНОГЕНЕТИЧЕСКИЕ И ФАРМАКОЛОГИЧЕСКИЕ ЭФФЕКТЫ ЛОКАЛЬНОГО ПРИМЕНЕНИЯ ГИАЛУРОНОВОЙ КИСЛОТЫ ПРИ ЭКСПЕРИМЕНТАЛЬНОЙ КОМПРЕССИОННОЙ ТРАВМЕ МЯГКИХ ТКАНЕЙ

Regional activation of cellular repair systems, including local application of hyaluronic acid, is a promising direction for the sanogenesis of muscle injuries. Purpose: to identify the sanogenetic and pharmacological effects of local application of hyaluronic acid in experimental soft tissue compression trauma. Compression injury was simulated by mechanical compression of the right pelvic limb of a rat at the level of the lower leg for 7 hours with a pressure force of 10-12 kg/cm2. Further, the animals were divided into 2 groups: 3 hours after decompression, animals in the main group were injected with 3.5% hyaluronic acid (the drug «Hyalift 3.5») by fan-pricking with a sterile disposable syringe at 5-6 points to a depth of 0.5-0.8 cm in a volume of up to 0.1 ml at each point; rats in the control group were given a similar method and an equivalent volume of 0.9% sodium chloride solution. The level of myoglobin in the blood, microcirculation, histomorphological and immuno- histochemical characteristics of tissues in the compression area were studied. A comprehensive analysis of the results of the study allowed us to establish that early local administration of 3.5% hyaluronic acid to the area of compression damage of soft tissues (3 hours after decompression) has a muscle-protecting effect, activates the repair system of damaged skeletal muscles. It is concluded that the sanogenetic effect of hyaluronic acid is mediated by the mecha- nisms of its pharmacological action: activation of angiogenesis, improvement of in situ efficiency of microcirculation and metabolism, reduction of the severity of primary and secondary necrosis and about traumatic disorders, activation of regeneration of damaged muscle fibers with the formation of muscle tissue. Hyaluronic acid is an active stimulant of reparative processes in the perspective of pharmacotherapy and may be a promising component in the local correction of extensive traumatic injuries.

Three-dimensional biofabrication: Our first impressions and its potential in Pediatric Surgery

Objective: The objective of the study was to design and produce a 3D bioprinter and to evaluate its potential uses in the field of Pediatric Surgery. The design and production of the device whose coordinates could be given with computer-controlled code and having the ability to move in three axes and print the contents of the cartridge on the stationary print bed were realized at the university 3D design and printing laboratories. The Ferret programming language was used for programming and exterior design was made according to the standard laminar cabin dimensions. A 20% gelatin (Sigma Aldrich, MI, USA) solution was used for three-dimensional bioprinting tests. For test bioprints scaffold model used in the field of tissue engineering, for open wound experimental dressing model and for organ-like structures ear model were selected. Scaffold structure was designed with Solidworks (Dassault Systemes,Velizy-Villacoublay, FR) software and open wound experimental dressing model was designed in Fusion360 (Autodesk, CA, USA) software. As an organ-like model, the ear structure has been segmented from the computed tomography images with Synapse3D (Fujifilm, Tokyo, JP) software and converted into “.stl” file. Our device was produced as a machine that can move in the x, y and z axes and can press the sterile syringe contents into the Petri dish in three dimensions. The three-dimensional prints of the scaffold, the experimental wound dressing model obtained from the wound photo and organ model obtained from the CT scan were successfully bioprinted. We think that three-dimensional bioprinters have a great potential in tissue engineering studies in the field of pediatric surgery and will add a brand-new dimension to our research capabilities. We conceive that recurrent cases of hypospadias which especially need tissue reinforcement, diaphragmatic and anterior abdominal wall defects seem to be the primary areas of study.

Assessment of Haematological Parameters of Pulmonary Tuberculosis Patients with and Without HIV Infection Attending Two Secondary Health Facilities in Jigawa State

TB and HIV form a lethal combination, as each fuels the progress of the other in the infected patients. This study assessed the haematological parameters of pulmonary tuberculosis (PTB) patients with and without HIV infection attending the two secondary health facilities in Jigawa State, Nigeria. A total of 150 PTB patients visiting the two secondary health facilities were randomly selected for the study. 5ml of venous blood was drawn aseptically with the help of sterile syringe using vein puncture technique and transferred into EDTA bottle to avoid coagulation. 2ml of the EDTA blood was transferred in to plane test tube for the haematological analysis using automated Haematological Analyser (Abacus Junior 380) while the remaining 3ml of the blood was placed into a Western green tube up to the zero mark for Erythrocyte sedimentation rate (ESR) determination. The data was analysed using SPSS version 20, One-way ANOVA was used to check the significant difference among the new, follow-up and Multi drug resistant TB (MDR-TB) groups of patients. 136 (90.67%) patients were HIV negative and 14 (9.33%) were HIV positive, 95 (63.33%) were males and 55 (36.37%) were females. Among the studied population 56 (37.33%) and 94 (62.67%) were new and follow-up PTB patients respectively. In this study, there were significantly lower mean values at (P>0.05) of White blood cells, lymphocytes, neutrophils (MID), granulocytes, Red Blood Cells, packed cells volume, and Platelets counts among PTB-HIV co-infected patients when compared with PTB patients. Of the PTB patients, 27.94% were Leukopenic, 25.7% Lymphopenic, 26.47% neutropenic, 30.88% anaemic and 20.59% thrombocytopenic. On the other hand, of the PTB-HIV co-infected patients, 64.29% were leukopenic, 35.71% lymphopenic, 26.47% neutropenic, 21.43% anaemic, and 14.29% thrombocytopenic. This study demonstrated high prevalence of leucopenia, followed by neutropenia and anaemia, lymphopenia, and thrombocytopenia. There was also high ESR values among more than two-third of the 150 PTB patients. The study also revealed that, females were more co-infected with HIV 64.29% than the males with 35.71%. HIV co-infection worsens haematological abnormalities of PTB patients. Knowledge of these haematological parameters will enhance the overall management of the PTB patients with regard to monitoring the disease progression and response to antimicrobial chemotherapy as they will serve as useful indicators for treatment success or failure. It is recommended that all newly diagnosed and follow-up PTB and PTB-HIV co-infected patients should be exposed to haematological counts to monitor their immune status.

The evolution of addiction treatment and harm reduction programs in Iran: a chaotic response or a synergistic diversity?

Iran has 2.1 and 1.8% of its 15-64-year-old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic Revolution. Iran's current drug treatment scene is a combination of services, ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases. In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15years later after facing the negative consequences. Addiction is viewed as a disease, and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift an extensive move towards harm reduction strategies and opioid-maintenance programs has been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended in the third shift starting in 2010, with extended compulsory court-based residential programs. Currently, there is a new shift towards reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization. Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.

Alpha S1-Casein Gene Polymorphısm in Nigerian Balami Sheep Breed Indigenous to Mubi

The study was conducted on five Balami sheep breed to determine and characterize the alpha S1 casein gene. Five blood samples were collected from each animal intravenously using sterile needle and syringe. The blood samples were placed in labelled tubes containing ethylene diamine tetraacetic acid (EDTA). The blood samples were transported in on ice cold chain container to the laboratory for analysis. Quick-DNA Miniprep TM kit used for DNA extraction and amplified using forward and reverse primers (CSN1S1F 5’-ACCCCTCAGGTACCCTAAGAAA-3’ and CSN1S1R 5’-GTTTATCCCCCACACTGCATTC-3’). The gene was sequenced and blasted against the NCBI database. Single nucleotide polymorphism analysis was performed to ascertain the variations. Multiple sequence alignment and phylogenetic analysis within and with the reference sequence was conducted online bioinformatics tools. Result from the analysis reveals that, the extracted DNA were found on chromosome 6, intron 16 and exon 17. The Balami breeds of sheep showed total number of polymorphic and monomorphic site of 68 and 600 respectively, and percentage of polymorphism of 10.18%. The Balami breed showed one amino acid substitution and genetic variation within breeds. Complete molecular characterization, genotyping and determination of allele frequency of alpha S1 gene in Balami breed of sheep indigenous to Nigeria and its variations is recommended for further research.

Estimated effect of US state syringe sale policy on source of last-used injection equipment

BackgroundMany people who inject drugs (PWID) lack access to a new sterile syringe each time they inject, with increased risk of injection-related harms, including spread of communicable diseases. In the United States (US), restricted access is largely due to state laws and policies regulating syringe access. Our aim in this US-focused study is to estimate variations in syringe acquisition behavior in relation to state-level syringe sale policies, drawing upon self-identified PWID in a nationally representative sample survey. MethodsEstimates were obtained on the source of the last used syringe from participants of the National Survey on Drug Use and Health (NSDUH) years 2002–2011. States were classified as having restricted syringe policies if they had any restriction on the sale of syringes during the study period (e.g., required a prescription or limited the number being sold). ResultsIn states with unrestricted syringe sale policies, PWID were more likely to have obtained their most recently used syringe from a safe source (Difference (%) = 9.8, 95% CI: 1.9, 17.7). This difference was largely driven by a larger percent of injectors obtaining syringes from a pharmacy in unrestricted states (Difference = 20.4, 95% CI: 12.2, 28.6) but was partially offset by fewer injectors obtaining syringes from syringe exchange programs (Difference = −10.7, 95% CI: −16.1, −5.3). ConclusionThese new findings, taken with other evidence, should help promote removal of policy barriers that now thwart syringe acquisition from a safe source. We hope this additional evidence will provoke policy discussions and may influence regulations that promote public health and reduce the spread of communicable diseases.

An 1H NMR study of the cytarabine degradation in clinical conditions to avoid drug waste, decrease therapy costs and improve patient compliance in acute leukemia.

Cytarabine, the 4-amino-1-(β-D-arabinofuranosyl)-2(1H)-pyrimidinone, (ARA-C) is an antimetabolite cytidine analogue used worldwide as key drug in the management of leukaemia. As specified in the manufacturers’ instructions, once the components—sterile water and cytarabine powder—are unpackaged and mixed, the solution begins to degrade after 6 hours at room temperature and 12 hours at 4°C. To evaluate how to avoid wasting the drug in short-term, low-dose treatment regimens, the reconstituted samples, stored at 25°C and 4°C, were analyzed every day of the test week by reversed-phase HPLC and high-field NMR spectroscopy. All the samples remained unchanged for the entire week, which corresponds to the time required to administer the entire commercial drug package during low-dose therapeutic regimens. The drug solution was stored in a glass container at 4°C in an ordinary freezer and drawn with sterile plastic syringes; during this period, no bacterial or fungal contamination was observed. Our findings show that an cytarabine solution prepared and stored in the original vials retains its efficacy and safety and can, therefore, be divided into small doses to be administered over more days, thus avoiding unnecessary expensive and harmful waste of the drug preparation. Moreover, patients who require daily administration of the drug could undergo the infusion at home without need to go to hospital. The stability of the aliquots would help decrease hospitalization costs.

204 Discriminating intrauterine growth-restricted piglets through near-infrared spectroscopy of amniotic fluids

The occurrence of intrauterine growth restriction (IUGR) is a great concern in animal production systems, leading to substantial economic losses. The multifactorial causes of IUGR make their prediction before or during pregnancy a challenging task. The amniotic fluid, containing chemical secretions of both the developing fetus and the amnion-allantois membrane, may offer a unique opportunity to investigate the causes of IUGR in piglets. Here we applied near-infrared spectroscopy (NIRS) as a rapid tool to discriminate the chemical composition of the amniotic fluid from IUGR fetuses at different gestational ages. The uteri of gravid sows were dissected at 60% (n=6 sows) and 90% (n=6 sows) of gestational age. Amniotic fluids were collected with a sterile 10-mL syringe connected to an 18-G needle under visual guidance, and samples without blood contamination were kept at 4°C while the fetus was measured. Samples were selected according to fetal weight and were classified as small (mean − 2 SD), medium (mean), and large (mean + 2 SD) sizes in each litter. Selected samples were kept at −80°C until NIRS transmittance spectra collection (350-2500nm). At 60% of gestational age, male fetuses weighed 96±1.2, 133±1.7, and 159±1.9g and female fetuses weighed 117±1.1, 137±1.8, and 152±1.8g for small, medium, and large groups, respectively. The fetal weights at 90% of gestational age averaged 517±0.6, 757±0.6, and 912±0.7g for males and 532±0.6, 718±0.9, and 911±0.6g for females for small, medium, and large sizes, respectively. Chemometric analysis of the amniotic fluid spectra was applied to the wavelength range 1300-1600nm using a balanced data set (n=425) with an 80/20 calibration/validation distribution for linear discriminant analysis (LDA-PCA). Overall, we were able to discriminate samples according to fetal size and gestational age; LDA-PCA showed the highest size classification occurring with spectra derived from the small fetuses with an accuracy of 94.5-100% and 100% and 70.6% for the calibration and validation processes from 60% and 90% of gestational age, respectively. By contrast, when the analysis considered each sex at 60% of gestational age, the medium and small fetuses presented the highest size classification for females and males correspondingly. At 90% of gestational age, the large fetuses presented the best discrimination for both sexes. In conclusion, we were able to detect and discriminate chemical changes of the amniotic fluid from different fetuses using NIRS, indicating that this fluid contains molecules that may characterise IUGR in piglets. These observations will permit future investigations to identify specific molecules associated with IUGR that would lead to possible real-time corrective actions before birth. This work was supported by USDA-ARS grant no. 58-6402-3-018.

Development of a New Method for the Microbiological Analysis of Radiopharmaceuticals Case of Iodine 131

The main aim of this study is to develop a new microbiological control method for the solution of iodine 131 in a closed system for radiopharmacy services not equipped with a class A Hot Cell dedicated to microbiological analysis according to GMP requirements. The method is based on the preparation of perforated petri dishes containing three culture media. The perforation of the Petri dishes was realized under a class A laminar flow hood using a heated metal cylindrical rod. A sterile magnetic stir bar was then placed in each Petri dish before closing the hole and sealing Petri dishes with autoclaving adhesive. First, the method was tested inside a class C room then inside an unclassified area by perforating the adhesive with a sterile syringe and injecting a volume of sterile water before the perforation was closed by a second sterile adhesive. Seeding was performed by moving each Petri dish on a magnet. Then the Petri dishes were incubated inside the Hot Cell at room temperature for Yeast and Mold at 32.5°C and for Total Aerobic Microbial and Total Coliform. A positive control (bacterial suspension) and a negative control (sterile water) were performed for each culture medium. Finally, the method was tested inside a class C Hot Cell for three production batches of sterile iodine-131. After 5 days incubation at 32,5°C and 7 days at room temperature, The Petri dishes was sterile for both tests performed in class C room and for the unclassified room. The same result was obtained with the solution of iodine131 in the three production batches. This new method has shown good efficiency to keep the sterility of culture medium during the microbiological analysis independently of the environmental class. It could be adopted by radiopharmacy services for the control of the solution of iodine131 and other radiopharmaceuticals. This method would make it possible to carry out the microbiological analysis of radiopharmaceuticals quickly without waiting for the decay. Moreover, it allows to minimize the risk of exposure of the laboratory technicians by iodine inhalation.

Novel Cost-Effective Tubular Port Based on Glove and Syringe for Endoscopic Surgery of Intracerebral Hematomas

Intracerebral hematomas (ICH) is a common disease in the developing countries, and minimally invasive transportal resection of ICH is a widely accepted surgical technique. Many port systems are available, but most are disposable and expensive. We present a safe and cost-effective glove-syringe substitute for endoscopic hematoma evacuation, suitable for developing countries such as China. A port substitute of different sizes and lengths was constructed using sterile gloves and syringes, commonly found in a surgical environment. We successfully performed endoscopic hematoma removal in 7 patients including 1 cerebellar hemorrhage case and the remaining 6 supratentorial basal ganglia cases (1 patient taking oral aspirin). Bipolar electrocoagulation was used to control bleeding from the ruptured blood vessels. There were no postsurgical complications. The glove-syringe port is a convenient, safe, and cost-effective tubular port system for endoscopic surgery of ICH. Such ports can be used as substitutes when commercial sleeves are unavailable, especially in rural areas and developing countries.

Serum uric acid concentration (SUAC): A useful tool to assess extent and severity of chronic plaque psoriasis in Pakistani population.

Objectives: Psoriasis is a systemic chronic inflammatory autoimmune disease. Psoriasis can lead to multiple complications and co-morbidities. It has also been observed that raised serum uric acid levels predispose to gouty arthritis and also thought to be a risk factor for cardiovascular mortality and morbidity. The basic aim of this study was to ascertain level of serum uric acid in patients with chronic plaque psoriasis and control cases which might be a useful tool for assessing the extent and severity of chronic plaque psoriasis. Study Design: Case control study. Setting: At Outpatient’s Department (OPD) of Department of Dermatology, PNS Shifa, Karachi. Period: From January 2013 to December 2016. Material &amp; Methods: One hundred and ninety four (194) patients were taken in this study and 97 patients were biopsy proven cases of psoriasis and 97 other participants included as control cases reporting to OPD with other complaint like acne, hair fall and fungal infections. After written and informed consent, 5ml of venous blood was drawn in sterile syringe and using gel sample tube to see the serum uric acid levels. On the basis of laboratory reports the elevated serum uric acid level in psoriatic versus normal controls was recorded on a pre-designed proforma. Results: There were 54.6% (106/194) male and 45.4% (88/194) female. Elevated serum uric level was 4.5 times (Approximate of 4.46) more common in cases than control group (OR: 4.46 95%CI: 1.83 to 10.91). Conclusion: Raised levels of serum Uric acid have been seen frequently in psoriatic patients. Early treatment for higher levels of serum uric acid might play a critical role in the better treatment of psoriatic patients. These results revealed that serum uric acid concentration (SUAC) of psoriasis may play a vital role in assessing the complex multifactorial etiology of the psoriasis, severity and other possible metabolic factors.

Extra-legal policing strategies and HIV risk environment: accounts of people who inject drugs in Nigeria

This article reports on an exploratory qualitative study investigating extra-legal policing practices and HIV vulnerability among injecting drug users. It draws upon thematic analysis of interview accounts of 29 street-involved PWID, recruited through snowball sampling in Uyo, Nigeria. The data emphasized that policing is a structural mechanism perpetuating drug-related harms and social suffering in the lives of PWID. Policing strategies, including searches, violence and confiscation of sterile needles and syringes, reproduce an environment of fear that undermines risk reduction and contributes to HIV risk via injecting in risky settings and receptive syringe sharing. Accounts highlighted humiliations, labeling and other expressions of contempt as forms of ‘moral policing’, which reinforce stigma and sanction human rights violations. Extra-legal policing practices, including violence, extortion and sexual harassments, adversely affect health and well-being. This raises questions about the effectiveness and legitimacy of policing and highlights a social justice perspective that may contribute to the reduction of health inequalities for PWID. It also provides a social justice and human rights rationale for advocacy for policy reforms, safe injection sites, needle and syringe distribution, oral drug substitution programs and rights-based, public health-oriented policing that enable access to harm reduction services for PWID.

Missed opportunities for prevention and treatment of hepatitis C among persons with HIV/HCV coinfection

ABSTRACT Hepatitis C (HCV) and HIV have common modes of transmission but information about HCV transmission risk, prevention, and treatment among persons with coinfection is lacking. The Medical Monitoring Project produces nationally representative estimates describing adults with diagnosed HIV in the United States. Using medical record data recorded during 6/2013–5/2017, we identified persons with detectable HCV RNA documented during the past 24 months. Among persons with coinfection, we described HCV transmission risk factors and receipt of HCV prevention services during the past 12 months and prescription of HCV treatment during the past 24 months. Overall, 4.9% had documented active HCV coinfection, among whom 30.2% were men who have sex with men (MSM), 6.7% reported injection drug use, and 62.1% were prescribed HCV treatment. Among MSM, 45.5% reported condomless anal sex and 42.3% received free condoms. Among persons who used drugs, 30.8% received drug or alcohol counseling, and among persons who injected drugs, 79.2% received sterile syringes. Among persons with HIV/HCV coinfection, recent drug injection was uncommon and most received sterile syringes. However, 1 in 3 were MSM, of whom half reported recent HCV sexual transmission risk behaviors. More than one-third of those with coinfection were not prescribed curative HCV treatment.

Sero-Detection of Leptospira hardjo in Cattle of Bhaktapur District of Nepal

Leptospira hardjo is the most commonly reported cause of leptospirosis among cattle globally. The objective of this study was to determine sero-detection of Leptospira hardjo in cattle of Bhaktapur district of Nepal. A cross-sectional study was conducted in cattle pockets located at 4 different village development committees (VDCs) in the Bhaktapur district of Nepal. The sample collection was done in cattle to determine the sero-detection of Leptospira hardjo from February 2014 to June 2014. A total of 176 serum samples were collected from four VDCs of Bhaktapur district namely Sipadol, Dhadikot, Duwakot and Nangkhel, selected purposively. Forty samples from Sipadol, 46 Dhadikot, 42 Duwakot and 48 from Nangkhel were collected. 5 ml of blood was collected aseptically from jugular vein using 5 ml sterile disposable syringe. After that blood was transferred to the plain vacutainer. The harvested sera were transferred to serum vials and stored at in -20˚c deep freeze of Central Veterinary Laboratory until used for ELISA test. For screening of Leptospira hardjo, the Leptospira hardjo antibody test kit, ELISA (Prionics, Netherlands) was used. ANOVA along with multiple comparison test Tukey was used to compare frequency of detection across different locations in Bhaktapur district using SAS 9.4. MS-Excel was used to manage ELISA data from four different VDCs and to extract information regarding frequency of detection. There was 5.11% sero-detection in cattle of Bhaktapur district. Location wise sero-detection was 5% in Sipadol, 4.3% in Dhadikot, 4.76% in Duwakot and 6.25% in Nangkhel. The study showed that the detection of Leptospira hardjo in cattle. There was no statistical difference (P&gt;0.05) between location suggesting that cattle in all areas are equally at risk of this pathogen. Further study is suggested on isolation and identification of disease in Nepal.&#x0D; Int. J. Appl. Sci. Biotechnol. Vol 7(3): 378-381

Take-home naloxone possession among people who inject drugs in rural West Virginia

BackgroundTake-home naloxone (THN) possession among people who inject drugs (PWID) in rural communities is understudied. Better understanding the nature of THN possession among rural PWID could inform the implementation of overdose prevention initiatives. The purpose of this research is to determine factors associated with rural PWID having recently received THN. MethodsData from a PWID population estimation study implemented in Cabell County, West Virginia were used for this research. Multivariable Poisson regression with a robust variance estimator was used to evaluate the independent effects of several measures (e.g., sociodemographics, structural vulnerabilities, substance use) on PWID having received THN in the past 6 months. ResultsForty-eight percent of our sample (n = 371) of PWID reported having received THN in the past 6 months. Factors associated with having received THN were: age (adjusted Prevalence Ratio [aPR] = 1.02; 95% Confidence Interval [CI]: 1.01–1.03), having recently accessed sterile syringes at a needle exchange program (aPR = 1.82; 95% CI: 1.35–2.46), believing that doctors judge people who use drugs (aPR = 1.50; 95% CI: 1.07–2.12), and having witnessed at least one non-fatal overdose in the past 6 months (aPR = 1.44; 95% CI: 1.06–1.94). Greater numbers of overdose events in the past 6 months were also associated with having received THN. ConclusionsAmong rural PWID in West Virginia, slightly less than half received THN in the past 6 months. Rural communities need overdose prevention interventions that are responsive to the unique needs of rural PWID, decrease stigma, and ensure PWID have access to harm reduction services and drug treatment programs.

I could take the judgment if you could just provide the service: non-prescription syringe purchase experience at Arizona pharmacies, 2018

BackgroundCommunity pharmacies are important for health access by rural populations and those who do not have optimum access to the health system, because they provide myriad health services and are found in most communities. This includes the sale of non-prescription syringes, a practice that is legal in the USA in all but two states. However, people who inject drugs (PWID) face significant barriers accessing sterile syringes, particularly in states without laws allowing syringe services programming. To our knowledge, no recent studies of pharmacy-based syringe purchase experience have been conducted in communities that are both rural and urban, and none in the Southwestern US. This study seeks to understand the experience of retail pharmacy syringe purchase in Arizona by PWID.MethodsAn interview study was conducted between August and December 2018 with 37 people living in 3 rural and 2 urban Arizona counties who identified as current or former users of injection drugs. Coding was both a priori and emergent, focusing on syringe access through pharmacies, pharmacy experiences generally, experiences of stigma, and recommendations for harm reduction services delivered by pharmacies.ResultsAll participants reported being refused syringe purchase at pharmacies. Six themes emerged about syringe purchase: (1) experience of stigma and judgment by pharmacy staff, (2) feelings of internalized stigma, (3) inconsistent sales outcomes at the same pharmacy or pharmacy chain, (4) pharmacies as last resort for syringes, (5) fear of arrest for syringe possession, and (6) health risks resulting from syringe refusal.ConclusionsNon-prescription syringe sales in community pharmacies are a missed opportunity to improve the health of PWID by reducing syringe sharing and reuse. Yet, current pharmacy syringe sales refusal and stigmatization by staff suggest that pharmacy-level interventions will be necessary to impact pharmacy practice. Lack of access to sterile syringes reinforces health risk behaviors among PWID. Retail syringe sales at pharmacies remain an important, yet barrier-laden, element of a comprehensive public health response to reduce HIV and hepatitis C among PWID. Future studies should test multilevel evidence-based interventions to decrease staff discrimination and stigma and increase syringe sales.