Viscosupplementation in the Therapy for Osteoarthritic Knee

Osteoarthritis (OA) is a degenerative disease that is spreading worldwide due to an aging population. This is not simply a disease caused by worn out joints, but a complex disease accompanied by various mechanisms such as inflammatory reactions. Among various joints, knee joints show degenerative changes earlier than other joints because they carry most of the weight load, causing social-economic problems. In the case of OA of the knee that does not respond to relatively simple conservative treatments such as physical therapy or medication, intra-articular injection is preferred. However, intra-articular injection drugs have limited effectiveness and uncertainties. There are several intra-articular viscous supplement drugs such as hyaluronic acid. Tissue regeneration active materials such as polydeoxyribonucleotide and polynucleotide are also newly used. The objective of this paper was to compare effects of intra-articular supplementation drugs used for degenerative arthritis of the knee.

Analysis of the relationship between the HbA1c screening results and the development and worsening of diabetes among adults aged over 40 years: a 4-year follow-up study of 140,000 people in Japan – the Shizuoka study

Background Hemoglobin A1c (HbA1c) levels are routinely measured during health check-ups and are used as an indicator of glycemic control in Japan. However, only a few studies have followed up individuals to assess the risk of diabetes development and worsening based on HbA1c screening results. This study evaluated the relationship between HbA1c screening results and the risk of diabetes development and worsening. Methods Data were collected from the Shizuoka Kokuho Database, a Japanese administrative claims database of insured individuals aged > 40 years. We included individuals available for follow-up from April 2012 to March 2018 who had not received any diabetes treatment before March 2014. HbA1c screening results were categorized into 4 groups based on the HbA1c levels at the 2012 and 2013 health check-ups: group A, those whose HbA1c levels were < 6.5% in 2012 and 2013; group B, those whose HbA1c levels > 6.5% in 2012 but < 6.5% in 2013; group C, those whose HbA1c levels were > 6.5% in 2012 and 2013; and group D, those whose HbA1c levels were < 6.5% in 2012 and > 6.5% in 2013. Logistic regression models were used to analyze diabetes development and worsening, defined as the initiation of diabetes treatment by March 2018 and the use of injection drugs by participants who initiated diabetes treatment by March 2018. Results Overall, 137,852 individuals were analyzed. After adjusting for covariates, compared with group A, group B was more likely to initiate treatment within 4 years (odds ratio: 22.64; 95% confidence interval: 14.66–34.99). In patients who initiated diabetes treatment by March 2018, injection drugs were less likely used by group D than by group A (odds ratio: 0.28; 95% confidence interval: 0.12–0.61). Conclusions Our study suggests that although HbA1c levels measured during health check-ups were correlated with the risk of diabetes development and worsening, HbA1c levels in a single year may not necessarily provide sufficient information to consider these future risks.

Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. Methods The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an ‘inverse’ cascade was created to assess gaps, including not being RNA tested, genotyped, or treatment initiated, stratified by sex. Results In 2019, 52,638 people with known sex were anti-HCV positive in BC; 37% (19,522) were women. Confirmatory RNA tests were received by 86% (16,797/19,522) of anti-HCV positive women and 83% (27,353/33,116) of men. Among people who had been genotyped, 68% (6756/10,008) of women and 67% (12,640/18,828) of men initiated treatment, with 94% (5023/5364) of women and 92% (9147/9897) of men achieving SVR. Among the 3252 women and 6188 men not yet treated, higher proportions of women compared to men were born after 1975 (30% vs. 21%), had a mental health diagnosis (42% vs. 34%) and had used injection drugs (50% vs. 45%). Among 1619 women and 2780 men who had used injection drugs and were not yet treated, higher proportions of women than men used stimulants (64% vs. 57%), and opiates (67% vs. 60%). Conclusions Women and men appear to be equally engaged into the HCV care cascade; however, women with concurrent social and health conditions are being left behind. Treatment access may be improved with approaches that meet the needs of younger women, those with mental health diagnoses, and women who use drugs.

Cutaneous Adverse Drug Reactions in Hospitalized HIV/AIDS Patients

Background: Cutaneous adverse drug reaction (CADR) is the most common manifestation of drug hypersensitivity in humanimmunodeficiency virus (HIV), which presented as maculopapular rash. The incidence of CADR is found to be more commonin untreated HIV patients, and the frequency is higher in severe immunodeficiency status. Early diagnosis and appropriatetreatment give better outcomes. Purpose: To evaluate the incidence and management of CADR in HIV and acquired immunedeficiency syndrome (AIDS) patients. Methods: A retrospective descriptive study of HIV/AIDS patients with CADR whowere hospitalized at Intermediate Care and Infectious Disease Centre Dr. Soetomo General Academic Hospital. Result: Therewere more CADR cases in 2017, accounted 2.35% of the total Intermediate Care and Infectious Disease Centre RSUD Dr.Soetomo General Academic Teaching Hospital ward patients. There were more male patients (62.5%), with the mostcommonly found at the age of 25-44 years (64.3%), and which mostly (89.3%) originated from Surabaya. The most commondiagnosis was morbiliform eruption (60.7%), main complaint was red spots all over the body (45%), all of which are obscureerythematous macules. The most common causes were Duviral + Neviral antiretroviral (46%) and the most common treatmentwas dexamethasone injection. Conclusion: The incidence of CADR increased in 2017. The most frequent manifestation wasmorbilliform eruption due to Duviral+Neviral as the first line ARV treatment. Skin management varies widely in form oftopical, oral, and intravenous injection drugs, mostly using steroid class, dexamethasone intravenous injection in particular.

Prevalence and patterns of illicit drug use in people with human immunodeficiency virus infection in Korea

Background Data on illicit drug use by Korean people infected with HIV are lacking. Here, we examined the prevalence and patterns of illicit drug use among people infected with HIV in Korea. Material and methods In this cross-sectional study, we included all patients infected with HIV who visited a tertiary care hospital in Korea from January 1990 to May 2020. Sociodemographic data of patients, including drug use, were collected at the first visit and during follow-up. Results Among 1,267 patients, 5.13% reported the use of an illicit drug in their lifetime, and 2.61% were users of injection drugs. The most commonly used drugs were cannabis/marijuana and methamphetamine, followed by nitrite inhalants, cocaine, dextromethorphan, carisoprodol, and 3,4-methylenedioxymethamphetamine. The illicit drug users tended to be younger than non-users, homosexuals/bisexuals, and infected with hepatitis C virus (HCV); they had a higher CD4+ cell count than non-users. Among 65 users of illicit drugs, only 24.6% revealed their drug use at the first visit interview, and 24.6% reported using two or more drugs in their lifetime. Individuals who used injection drugs were more likely to be arrested for drug-related charges than the users of non-injection drugs. Moreover, they tended to be heavy users of illicit drugs, to report using two or more drugs in their lifetime, and to be HCV seropositive. In contrast, the users of non-injection drugs were more likely to be experimental users and to start using drugs overseas for the first time, but less likely to report their drug use at the first interview. Conclusions The prevalence of illicit drug use in people with HIV infection in Korea may have been underestimated. Further research based on more accurate measurements are warranted.

The Risk Factors of Phlebitis in The Installation of Intravent Catalysts

Background: A hospital is a health service facility that allows nosocomial infections, namely phlebitis. Phlebitis is a complication of intravenous catheter placement that is characterized by redness, pain, swelling, and fever. The high rate of phlebitis in various countries is due to the risk factors that predispose to the incidence of phlebitis due to intravenous catheter placement.Objective: This study aims to determine the risk factors for phlebitis in intravenous catheter placement.Methodology: This study uses an observational analytic method with a cohort design. The study was conducted on 27 February - 14 March 2020 with 22 samples taken using purposive accidental sampling in the inward and RST surgery Dr. Soedjono Magelang. The instrument used was an observation sheet designed by researchers that had been tested by experts and a standard operational checklist for infusion. Data analysis uses a chi-square test and multiple logistic regression.Results: The incidence of phlebitis was 7 respondents (31.8%) and the associated risk factors were the type of infusion fluid (RR = 4.37 CI 95% 1.09-17.58; p-value 0.020). While the factors of age, sex, nutritional status, chronic diseases, types of injection drugs, insertion location, duration of installation, nurse skills, installation techniques, and catheter size were not related to the incidence of phlebitis (p-value 0.05).Conclusion: Although several factors are not related to the incidence of phlebitis, these factors can be a support for the incidence of phlebitis.

The Process of Injection Drug Use Among Homeless Women in Ottawa, Canada: A Qualitative Study

BackgroundThe literature on women who use injection drugs (WUIDs) is antiquated and diluted by data from men. Due to the higher rates of morbidity and mortality among WUID, we undertook a qualitative study to better understand their drug use practices.MethodsWe adopted a Deleuze–Guattarian lens and engaged in semi-structured interviews with 35 women in Ottawa, Canada. Data from 31 of these women were analyzed using applied thematic analysis.ResultsWe divided these themes into (a) how WUID obtain resources to acquire drug,and (b) the steps involved in preparing, using, and discarding drugs. From our Deleuzo–Guattarian perspective, these findings highlighted that participants stratified their worlds according to rules of cleanliness to create hierarchies of appropriateness and acceptability.ConclusionsThese findings, overall, highlight the importance of understanding the constructed world of WUIDs, particularly regarding the ways in which nurses interact with these women to provide care.

Development and Worsening of Diabetes Among Adults Aged Over 40 Years: A 6-Year Follow-Up Study of 140,000 People in Japan – The Shizuoka Study

Background Hemoglobin A1c (HbA1c) levels are commonly measured during health check-ups and used as an indicator of diabetes. However, the contribution of screening tests to the prevention of the future development of diabetes is scarcely analyzed. We evaluated the relationship between HbA1c screening results and future risk of diabetes development and worsening. Methods We used the Shizuoka Kokuho Database, a Japanese administrative claims database of insured persons aged > 40 years. Individuals available for follow-up during 2012–2017 and who had not received any diabetes treatment before 2013 were considered. We constructed logistic regression models to evaluate the association of the likelihood of initiating diabetes treatment by 2017 with the number of health check-ups received after 2013, HbA1c levels, and trend changes at the 2013 health check-up and assess the likelihood of using injection drugs. Results Overall, 137,852 individuals were analyzed. Compared to the normal HbA1c Group (HbA1c < 6.5%) with no trend changes, the normal group with improving trends had higher odds (odds ratio 22.64; 95% confidence interval 14.66–34.99) of starting treatment within 4 years. Among people with diabetes treatment initiated by 2017, injection drugs were more likely used in the normal group than in the diabetes group (HbA1c ≥ 6.5%). Higher numbers of health check-ups were significantly associated with lower likelihoods of starting injection drugs. Conclusions Good control of HbA1c levels, as indicated by the results of the health check-ups, might have led to insufficient attention to lifestyle habits, which might have resulted in a deterioration of glycemic control.