Pre-exposure prophylaxis recent adherence with real-time adherence feedback and partner HIV self-testing: A pilot trial among postpartum women

Background Pre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. HIV self-testing (HIVST) for male partners combined with biofeedback counselling through real-time adherence measures may improve PrEP use among postpartum women. Methods Between August-2020-April-2021 we randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counselling following urine tenofovir test) or to standard of care (SOC: facility-based HIV tests and routine counselling without biofeedback). The outcomes of interest were PrEP adherence in the past 48-72 hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomisation. Secondary outcomes included proportion of partners who tested for HIV and discrepancy between self-reported PrEP adherence and urine tenofovir result. Results We enrolled 106 women (median age=26yrs). At enrolment 72% of women reported missing <2 doses in the past 7-days; 36% of women had tenofovir present in her urine. One month after enrolment, 62% (n=33) of women in the intervention arm had tenofovir present in their urine compared to 34% (n=18) in SOC (RR=1.83; 95% CI=1.19-2.82; p=0.001). Two-thirds of women in the intervention arm reported that her partner tested for HIV (66%; n=35); compared to 17% (n=9) in SOC (RR=3.89; 95% CI=2.08-7.27; p<0.001). Self-reported PrEP adherence (took PrEP >5 of last week) with no tenofovir in urine test was lower in the intervention group (17% vs 46%; RR=0.33; 95% CI=0.17-0.67; p=0.03). No social or clinical adverse events were reported in the intervention arm. Conclusions HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.

Mean corrected generalized estimating equations for longitudinal binary outcomes with report bias

Cocaine addiction is an important public health problem worldwide. Cognitive-behavioral therapy is a counseling intervention for supporting cocaine-dependent individuals through recovery and relapse prevention. It may reduce patients’ cocaine uses by improving their motivations and enabling them to recognize risky situations. To study the effect of cognitive behavioral therapy on cocaine dependence, the self-reported cocaine use with urine test data were collected at the Primary Care Center of Yale-New Haven Hospital. Its outcomes are binary, including both the daily self-reported drug uses and weekly urine test results. To date, the generalized estimating equations are widely used to analyze binary data with repeated measures. However, due to the existence of significant self-report bias in the self-reported cocaine use with urine test data, a direct application of the generalized estimating equations approach may not be valid. In this paper, we proposed a novel mean corrected generalized estimating equations approach for analyzing longitudinal binary outcomes subject to reporting bias. The mean corrected generalized estimating equations can provide consistently and asymptotically normally distributed estimators under true contamination probabilities. In the self-reported cocaine use with urine test study, accurate weekly urine test results are used to detect contamination. The superior performances of the proposed method are illustrated by both simulation studies and real data analysis.

EARLY REHABILITATION OF CRITICAL TESTICULAR ISCHEMIA WITH ACUTE TORSION IN CHILDREN

Introduction. Acute testicular torsion is an urgent condition characterized by chorda spermatica turn and torsion with its vessels along vertical or horizontal axis. This condition results in testicular ischemia and loss of organ in case of lack of timely medical care. If a child is operated on within 6-12 hours their chance for complete recovery is decreased to 70 %. The timeline of 12-24 hours leaves only a 20% chance to keep a testicle. After 24 hours since the beginning of the condition there is virtually no chance to keep organ’s viability. The goal of the research is an optimization of early rehabilitation of critical testicular ischemia in children with acute testicular torsion. Material and methods. Over the period of the years 2010 – 2021 54 children with testicular torsion were observed and treated. Eight children got to a hospital as in-patients within first six hours from condition establishment, eight patients turned to a hospital within the period of 6.1-12 hours, 11 patients addressed hospital after 12.1-16 hours, 16 patients did so after 16.1-24 hours, and 11 patients addressed hospital after more than 24 hours since condition had been established. All patients with testicular torsion were admitted to a hospital in an urgent manner, their general condition was assessed as "moderate". Time before surgery was limited (up to 1 hour from the moment of hospitalization). Therefore, the examination of patients was minimized by a general blood test, a general urine test (83.3 %), determination of blood group and Rh-factor, measuring arterial pressure. A testicle was verified as viable in 12 children (22.2 %). Genital gland necrosis was diagnosed in 22 patients (40.8 %), they underwent orchophuniculectomia. Critical testicle ischemia was diagnosed in 20 boys (37 %). All patients were operated on. In all cases operation started not later than an hour after hospitalization. For 45 children operation was performed via inguinal access (83.3 %), transscrotal access was used in 9 patients (16.7 %). In all cases when a testicle was viable invasive detorsion with further orchiopexy was used. All children who underwent testiculectomy were hospitalized later than 16 hours after the onset of the disease. All boys with critical testicle ischemia underwent rehabilitation measures during operation. Results. Among children with genital gland critical ischemia 10 patients (52.6 %) recovered completely. Children who had been hospitalized during 6-12 hours after the onset of the disease were discharged from a hospital ward on the 5-7 day after operation. Two children (25 %) in this group had further testicle autolysis. Among children who addressed for healthcare support within 12–16 hours after the condition establishment, two patients (18.2 %) recovered completely. Five patients (50 %) had testicle autolysis in the postoperative period. Conclusions. 1. Critical testicular ischemia is observed in 35.2 % children with acute testicular torsion. 2. Early rehabilitation measures include a complex of conservative and operational approaches implemented in pre-operational, intra-operational and early post-operational periods. 3. Timely and full-fledged rehabilitation measures implementation allows to improve results of operational treatment and save affected genital gland with critical ischemia in 50 % of patients.

Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes

<b>Objective</b> <p>To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.</p> <p><b>Research Design and Methods</b></p> <p>Of 295 adults with type 1 diabetes who were seen with DKA related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed. Cannabis use was defined as positive urine test for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥ 15) and sensitivity and specificity were calculated using receiver operating characteristic (ROC).</p> <p><b>Results</b></p> <p>Cannabis users had significantly higher pH (7.42 ± 0.01 vs 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs 9.1 ± 0.71) (p<0.0001) compared to non-users. The area under the ROC for positive cannabis urine test predicting HK-CHS was 0.9892.</p> <p><b>Conclusions</b></p> <p>In patients who present with DKA and higher pH, especially pH ≥ 7.4, cannabis use should be considered in differential diagnosis.</p>

Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes

<b>Objective</b> <p>To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.</p> <p><b>Research Design and Methods</b></p> <p>Of 295 adults with type 1 diabetes who were seen with DKA related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed. Cannabis use was defined as positive urine test for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥ 15) and sensitivity and specificity were calculated using receiver operating characteristic (ROC).</p> <p><b>Results</b></p> <p>Cannabis users had significantly higher pH (7.42 ± 0.01 vs 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs 9.1 ± 0.71) (p<0.0001) compared to non-users. The area under the ROC for positive cannabis urine test predicting HK-CHS was 0.9892.</p> <p><b>Conclusions</b></p> <p>In patients who present with DKA and higher pH, especially pH ≥ 7.4, cannabis use should be considered in differential diagnosis.</p>

Methamphetamine use among people who inject heroin in Hanoi, Vietnam

Introduction: The pattern of drug use in Vietnam has changed rapidly over the past decade, and a large number of people who have a history of heroin injection reportedly use methamphetamine. This paper describes factors associated with methamphetamine use among people who inject heroin in Hanoi, the capital of Vietnam. Methods: This is a cross-sectional survey among 521 heroin injectors who were recruited through chain referral and outreach at community and clinic settings. Eligibility criteria included: (1) male aged 18 or older; (2) reported heroin injecting during the 12 months before the survey; (3) agreed for a urine test to detect methamphetamine and opiate metabolites. The primary outcome, methamphetamine use, was defined as selfreported methamphetamine use during the 30 days before the survey and/or having a urine test positive for methamphetamine. Structural Equation Model was used to evaluate associated factors for methamphetamine use. Results: One third of participants qualified as methamphetamine users as defined in this study. A longer history of heroin use (β=0.126, p<0.001), using MDMA and/or cannabis (β=0.28, p<0.001) and not using condom during sex (β=0.139, p<0.001) were positively associated with methamphetamine use. Family functioning (β=-0.141; p<0.001) was protective. The goodness-of-fit of Structural Equation Model was excellent (CFI=0.934; TLI=0.912; RMSEA=0.033; WRMR=0.98). Conclusions: Methamphetamine use among people who inject heroin is a substantial issue in Hanoi. Family functioning has made a critical contribution on reducing methamphetamine use. Future studies should pay attention to address the role of factors at the family level in addition to individual-level factors towards the pattern of drug use.