A syndemic examination of injecting drug use, incarceration and multiple drug-related harms in French opioid users

Purpose People who inject drugs (PWID) face multiple health problems, including infectious diseases and drug overdoses. Applying syndemic and risk environment frameworks, this paper aims to examine the co-occurrence and clustering of drug-related harms and their association with incarceration experience with or without in-prison drug injection. Design/methodology/approach The authors used data from a cross-sectional survey conducted in 2015 among 557 active opioid injectors. Self-reported data were collected through face-to-face or online questionnaires. They distinguished three harm categories, namely, viral infections, bacterial infections and overdoses, and built an index variable by summing the number of harm categories experienced, yielding a score from 0 to 3. Association between incarceration experience and co-occurrence of harms was modelled using a multinomial logistic regression. Findings Of the 557 participants, 30% reported lifetime experience of drug-related viral infection, 46% bacterial infection and 22% drug overdose. Multinomial logistic models showed that those who injected drugs during incarceration were more likely to report two (aOR = 2.35, 95% CI: 1.03–5.36) and three (aOR = 9.72, 95% CI: 3.23–29.22) harm categories than those who had never been incarcerated. They were also more likely to report three harm categories than formerly incarcerated respondents who did not inject drugs in prison (aOR = 5.14, 95% CI: 1.71–15.48). Originality/value This study provides insights of the syndemic nature of drug-related harms and highlights that drug injection during incarceration is associated with co-occurring harms. Public health interventions and policy changes are needed to limit the deleterious impact of prison on PWID.

Comparison of infiltration (INF) and inferior alveolar nerve block (IANB) injection techniques in bilateral therapeutic removal of mandibular premolars

Background. The present study aimed to evaluate and compare the anesthetic effect of infiltration (INF) and inferior alveolar nerve block (IANB) techniques for bilateral therapeutic extraction of mandibular premolars. Methods. One hundred patients requiring bilateral therapeutic removal of mandibular premolars were included in the study. For the extraction of the mandibular right premolar tooth, INF was used, and after one week, the mandibular left premolar tooth was extracted using the IANB. The effect of anesthesia between the two techniques was compared and evaluated by ANOVA using SPSS. Results. INF was successful in 78% of cases, whereas IANB was successful only in 22% of cases. Furthermore, INF had a significantly better anesthetic effect than IANB (P<0.05). During pain assessment during the anesthetic drug injection and the procedure, two patients in the INF and five patients in the IANB group reported minimal pain during extraction (P>0.05). The onset of the anesthetic effect was faster in the INF group, while the duration of the effect was longer in the IANB group. Conclusion. INF was a more efficacious local anesthetic technique with high success rate than the IANB technique.

Comparison of Intravenous Dexmedetomidine versus Labetalol for Their Effectiveness in Suppression of Haemodynamic Response during Extubation

Background: Tracheal extubation causes autonomic nervous system disturbances which causes tachycardia, hypertension which are harmful in susceptible patients.so we conducted a study between iv Dexmedetomidine and iv Labetalol to assess their effectiveness in decreasing haemodynamic disturbances during extubation. Materials and Methods:we included 100 participants of age of 18-55 yrs with ASA grading I & II and divided them into 2 groups. Group D was given injection Dexmedetomidine 0.6mcg/kg iv and Group L was given injection Labetalol 0.25mg/kg body weight. We recorded Heart rate, systolic and diastolic blood pressure at baseline, 2,5,8 minutes post drug injection, at extubation and 1,3,5,8,10 and 15 minutes after extubation. Results: Group D had better decreased heart rate, systolic and diastolic blood pressure at the time of extubation, and also 15 minutes post extubation in comparison to Group L. Conclusion: Injection Dexmedetomidine 0.6µg/kg has showed a better attenuating effect on sympathoadrenal system during extubation than injection Labetalol 0.25mg/kg Keywords: Dexmedetomidine, labetalol, extubation,hemodynamics.

Prevalence of Hepatitis B and Hepatitis C Infections among Incarcerated Individuals in Iran: A Cross-Sectional National Bio-behavioral Study in 2019

Introduction: To realize the global goals of eliminating hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030, it is necessary to monitor the status of disease among target populations and undertake the required interventions. This study is the third round of surveys to determine the prevalence of hepatitis B and C infections among incarcerated individuals in different provinces of Iran. Methods: This study was conducted in five provinces of Iran (including Kurdistan, Ardabil, West Azerbaijan, Markazi, and Semnan) in 2019. The subjects of the study were selected from incarcerated people in prisons of all provinces that had not been studied in the previous two rounds of the surveys (in 2015 and 2016) in Iran. In this study, 15 prisons were selected and 2475 incarcerated individuals were enrolled into the study based on the multistage sampling method; the selected subjects were surveyed and their dried blood spot (DBS) samples were collected to test HBsAg and HCV-Ab. In cases with a reactive result for HCV-Ab, an HCV-RNA test was also performed on their serum samples. The relationships between independent variables and outcomes were evaluated via logistic regression. Results: Of all participants (2475 subjects) enrolled in the study, 54.18% were selected from northern provinces and 45.82% from the central provinces. The prevalence of HCV-Ab and HBsAg among incarcerated individuals was 5.66% (95% CI: 4.81% to 6.64%) and 2.42% (95% CI: 1.89% to 3.11%), respectively. Among HCV-seropositive individuals, 73.68% (95% CI: 64.70% to 81.01%) had current HCV infection (detectable HCV-RNA). The results showed that histories of imprisonment, drug use, unprotected sexual contact, drug injection, tattooing, and younger age in the first-time drug use in incarcerated individuals significantly increased the risk of HCV transmission. Among these behaviors, drug injection was more likely than other behaviors to result in contracting HCV in incarcerated individuals (OR: 22.91; 95% CI: 14.92–35.18; p < 0.001). Conclusion: To achieve international and national strategies targeted to eliminate HCV and HBV by 2030, it is necessary to pay special attention to prisons in Iran. It is recommended to continue HBV vaccination of eligible people in prisons. Developing screening and treatment protocols for individuals with HCV infection in prisons can help the country to achieve HCV elimination goals.

1215. A Mixed Methods Study on Severe Bacterial Infections in People Who Inject Drugs

Background Severe bacterial infections (SBI) associated with intravenous drug use have been increasing in frequency in the U.S. over the last decade. This mixed methods study aims to identify the risk factors associated with SBI in hospitalized individuals with recent injection drug use. Methods We conducted 34 quantitative and 15 qualitative interviews between August 2020 and June 2021 at Bellevue Hospital in New York City. Eligible participants were (1) &gt;/= 18 year of age, (2) admitted with a SBI, and (3) reported injection drug use within the 90 days prior to admission. Quantitative and qualitative data was obtained using a quantitative survey and in-depth, semi structured interviews of participants respectively. Analysis was performed to examine trends and explore common themes potentially contributing factors to SBI. Results Of the 34 participants included, the median age was 37.5, 85% were male, 53% white, and 65% reported being homeless within the past 3 months. Endocarditis was the most common primary diagnosis (65%). Median length of hospital stay was 24 days and 35% required ICU level care during admission. A causative microorganism was identified in 85% of participants and 50% had Staphylococcus aureus as the sole organism. Discharges against medical advice occurred in 35%. Daily injection drug use in prior 30 days was 95% with a median of 10 injections per day. In the 30 days prior to admission, 50% reported an increase in injection frequency, 80% reported reusing needles and/or syringes, 75% reused cookers, 65% reused cottons. Analysis of qualitative interview data revealed high risk injection behaviors. Participants were not practicing and unaware of strategies to reduce their risk of drug injection-related SBI. Prior hospitalizations for SBI did not impact on this knowledge deficit on what constitutes bacterial infection risk and how to prevent it. Conclusion Study findings highlight the complexity of the injection drug use process and the potential social and physiological pathways leading to SBI. Multiple domains at the structural, network, and individual level that impact drug injection practices and provide context by which these factors predispose and lead to physiological tissue damage and the development of SBI among PWID. Disclosures Benjamin Eckhardt, MD, MS, Gilead Sciences (Grant/Research Support)

Comparison of pretreatment with low-dose midazolam in combination with fentanyl and midazolam alone on the occurrence of etomidate-induced myoclonus—a randomized, double-blind study

Background Myoclonus is reported to occur in 50–80% of patients receiving etomidate in the absence of pretreatment. The study aimed to evaluate the efficacy of pretreatment with low-dose midazolam and fentanyl, and midazolam alone to reduce the occurrence of etomidate-induced myoclonus. Sixty patients were randomly divided into 2 groups. In group MF, patients received pretreatment with intravenous (IV) midazolam 0.015mg/kg in a volume of 5 ml normal saline, followed by IV fentanyl 1μg/kg in a volume of 5 ml normal saline. In group M, patients received pretreatment with IV midazolam 0.03mg/kg in a volume of 5 ml normal saline, followed by 5ml of IV normal saline. The test drug was injected over 30 s, and after 120 s, IV etomidate 0.3 mg/kg was injected over 30 s. The patients were observed for 120 s for myoclonus and graded as mild, moderate, or severe. Heart rate, blood pressure, and oxygen saturation were recorded immediately after test drug injection and at every minute for 5 min. Results The demographic parameters and hemodynamic parameters were comparable between the two groups. In group M, the incidence of myoclonus was 36.67% (26.67% mild and 10% moderate) whereas, in the group MF, the incidence of myoclonus was 26.67% (3.33% mild, 16.67% moderate, and 6.67% severe). This incidence of myoclonus was significantly lower in group MF (p=0.030). Conclusions The incidence of etomidate-induced myoclonus is significantly lower in patients pretreated with midazolam and fentanyl combination as compared to midazolam alone. Trial registration Clinical Trial Registry Details: CTRI/2019/05/018920

Feasibility of a Drug-Releasing Radiofrequency Ablation System in a Porcine Liver Model

The objective of this study was to investigate the feasibility of a newly developed anticancer drug-releasing radiofrequency ablation (RFA) system in a porcine liver model. A 15-gauge drug-releasing cooled wet electrode (DRCWE) was newly developed to improve the RFA efficacy for creating a large ablation as well as for simultaneously delivering an anticancer drug to the tumor margin. Nine ablations in three pigs were performed by the DRCWE. The sectioned liver specimens were evaluated by measuring the ablation zone by a positron emission tomography/magnetic resonance imaging examination to investigate whether 18F-fluorodeoxyglucose was exactly diffused. Volumes of the ablation zones released drug injection volumes, circularity, retention rate defined as the ratio between an estimated and injection dose, and the standard uptake value were assessed. The drug-releasing RFA was technically successful without procedural-related complications. During the procedure, the color changes of the ablated zones of the liver were observed in all specimens. The mean drug injection volume was higher than the ablated volumes (17.21 ± 2.85 vs. 15.22 ± 2.30 cm3) and the circularity was 0.72 ± 0.08. Moreover, the retention rate was 72.89% ± 4.22% and the mean standard uptake value was 0.44 ± 0.05. The drug-releasing RFA system was feasible not only for local ablation but also for the delivery of anticancer drugs. The results of this study indicate that this novel strategy of localized RFA with a drug delivery system could be a promising option for the prevention of local recurrence rates.

Sexualized drug injection among men who have sex with men in Madrid and Barcelona as the first episode of drug injecting

Background We estimate the prevalence of drug injection, the variables associated with having ever injected and the proportion of ever injectors whose first drug injection was for having sex; we describe the first drug injection episode, analyze the drugs most frequently injected and estimate the prevalence of risky injecting behaviors. Methods The participants were 3387 MSM without a previous HIV diagnosis attending four HIV/STI diagnosis services in Madrid and Barcelona. Lifetime prevalence and prevalence ratios (PRs) by different factors were calculated using Poisson regression models with robust variance. We compared the characteristics of first drug injection episode, lifetime injection and risky injecting behaviors of those whose first injection was for sex (FIS) with those whose was not (non-FIS). Results Lifetime prevalence of injection was 2.1% (CI 1.7–2.7). In the multivariate analysis, it was strongly associated with having been penetrated by more than five men in the last 12 months (aPR = 10.4; CI 2.5–43.4) and having met most of their partners at private parties (aPR = 7.5; CI 4.5–12.3), and less strongly with other factors. Of those who had ever injected drugs, 81.9% injected for sex the first time they injected drugs (FIS). At first injection, FIS participants had a mean age of 31 years, 62.7% used mephedrone and 32.2% methamphetamine on that occasion. Of this FIS group 39.0% had ever shared drugs or equipment and 82.6% had always shared for sex. Some 30.8% of non-FIS reported having also injected drugs for sex later on. Conclusions Only two out of a hundred had ever injected, most to have sex and with frequent drug or injecting equipment sharing. Injecting for sex is the most common first episode of drug injection and is the most efficient risky behavior for the transmission of HIV, hepatitis B or C and other blood-borne infections. MSM participating in private parties should be considered a priority group for prevention policies.

The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV: a systematic review and meta-analysis

Background Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common among individuals with human immune deficiency virus (HIV) infection worldwide. In this study, we did a systematic review and meta-analysis of the published literature to estimate the global and regional prevalence of HCV, HBV and HIV coinfections among HIV-positive prisoners. Methods We searched PubMed via MEDLINE, Embase, the Cochrane Library, SCOPUS, and Web of science (ISI) to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV. We used an eight-item checklist for critically appraisal studies of prevalence/incidence of a health problem to assess the quality of publications in the included 48 cross-sectional and 4 cohort studies. We used random-effect models and meta-regression for the meta-analysis of the results of the included studies. Results The number of the included studies were 50 for HCV-HIV, and 23 for HBV-HIV co-infections. The pooled prevalence rates of the coinfections were 12% [95% confidence interval (CI) 9.0–16.0] for HBV-HIV and 62% (95% CI 53.0–71.0) for HCV-HIV. Among HIV-positive prisoners who reported drug injection, the prevalence of HBV increased to 15% (95% CI 5.0–23.0), and the HCV prevalence increased to 78% (95% CI 51.0–100). The prevalence of HBV-HIV coinfection among prisoners ranged from 3% in the East Mediterranean region to 27% in the American region. Also, the prevalence of HCV-HIV coinfections among prisoners ranged from 6% in Europe to 98% in the East Mediterranean regions. Conclusions Our findings suggested that the high prevalence of HBV and HCV co-infection among HIV-positive prisoners, particularly among those with a history of drug injection, varies significantly across the globe. The results of Meta-regression analysis showed a sliding increase in the prevalence of the studied co-infections among prisoners over the past decades, rising a call for better screening and treatment programs targeting this high-risk population. To prevent the above coinfections among prisoners, aimed public health services (e.g. harm reduction via access to clean needles), human rights, equity, and ethics are to be seriously delivered or practiced in prisons. Protocol registration number: CRD42018115707 (in the PROSPERO international). Graphic abstract