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Abdalkareem Jasim S, Thaeer Hammid A, Turgunpulatovich Daminov B, Kadhem Abid M, Lateef Al-Awsi GR, Afra A, Ekrami HA, Ameer Muhammed FA, Mohammadi MJ. Investigation ways of causes needle sticks injuries, risk factors affecting on health and ways to preventive. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:629-636. [PMID: 35962992 DOI: 10.1515/reveh-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
Needle sticks injuries (NSIs) has caused many health concerns, including the widespread infection disease. Needle sticks injuries can have high threaten health human especially, all those who are in contact with health and medical centers. The purpose of this review study was the determination the effects of needle sticks injuries (NSIs) on health care worker and patents. In this a review study of literature studied conducted on international databases included Google Scholar, ISI/WOS (Web of Science), Springer, Scopus, Medline/PubMed. The literature signs a notable undesirable affect from potential needle sticks injuries related to ways to preventive and risks factors among patents and health care worker. The literature was shown needle stick injuries can cause with a variety of ways including needle recapping, non-standard safety boxes, thin gloves, and inadequate personal protective equipment. According to the result this study, needle stick injuries can transfer infectious disease (Human Immunodeficiency viruses [HIV], Hepatitis C virus [HCV]) and increase risk health on health care worker and patients. According to research related to the subject, the ways to prevent reduce needle sticks include personal protective equipment, holding retraining courses for medical staff in the direction to raise awareness can significantly reduce cases of needle sticks injuries. Further research using more sophisticated methodology is warranted.
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Affiliation(s)
- Saade Abdalkareem Jasim
- Medical Laboratory Techniques Department, Al-maarif University College, Al-anbar-Ramadi, Iraq
| | - Ali Thaeer Hammid
- Computer Engineering Techniques Department, Faculty of Information Technology, Imam Ja'afar Al-Sadiq University, Baghdad, Iraq
| | | | - Mohammed Kadhem Abid
- Department of Anesthesia, College of Health & medical Technology, Al-Ayen University, Thi-Qar, Iraq
| | | | - Arghavan Afra
- Department of Nursing, School of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Hafez Ajam Ekrami
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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2
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Varanda J, Santos JM. It Was Not the Perfect Storm: The Social History of the HIV-2 Virus in Guinea-Bissau. Trop Med Infect Dis 2023; 8:tropicalmed8050261. [PMID: 37235309 DOI: 10.3390/tropicalmed8050261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The perfect storm model that was elaborated for the HIV-1M pandemic has also been used to explain the emergence of HIV-2, a second human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) that became an epidemic in Guinea-Bissau, West Africa. The use of this model creates epidemiological generalizations, ecological oversimplifications and historical misunderstandings as its assumptions-an urban center with explosive population growth, a high level of commercial sex and a surge in STDs, a network of mechanical transport and country-wide, en masse mobile campaigns-are absent from the historical record. This model fails to explain how the HIV-2 epidemic actually came about. This is the first study to conduct an exhaustive examination of sociohistorical contextual developments and align them with environmental, virological and epidemiological data. The interdisciplinary dialogue indicates that the emergence of the HIV-2 epidemic piggybacked on local sociopolitical transformations. The war's indirect effects on ecological relations, mobility and sociability were acute in rural areas and are a key to the HIV-2 epidemic. This setting had the natural host of the virus, the population numbers, the mobility trends and the use of technology on a scale needed to foster viral adaptation and amplification. The present analysis suggests new reflections on the processes of zoonotic spillovers and disease emergence.
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Affiliation(s)
- Jorge Varanda
- Centre for Research in Anthropology (CRIA-UC), Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine-NOVA-Lisbon (GHTM-UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
| | - José Maurício Santos
- Centre for Geographical Studies, Institute of Geography and Spatial Planning, Universidade de Lisboa, 1600-276 Lisboa, Portugal
- Associated Laboratory TERRA, 1349-017 Lisboa, Portugal
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3
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Shao S, Wang S, Ren L, Wang J, Chen X, Pi H, Sun Y, Dong C, Weng L, Gao Y, Wang L. Layer-by-Layer Assembly of Lipid Nanobubbles on Microneedles for Ultrasound-Assisted Transdermal Drug Delivery. ACS APPLIED BIO MATERIALS 2022; 5:562-569. [PMID: 35021618 DOI: 10.1021/acsabm.1c01049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Microneedles as a typical device for transdermal drug delivery provide an alternative route for drug administration with minimal digestion by organs and better patient compliance. However, diffusion of passively released drug molecules within the skin tissue mainly depends on the interstitial fluid, which may be affected by different physiological conditions of individuals. Herein, we propose a nanobubble-modified microneedle patch for ultrasound-assisted drug delivery, which provides additional driving force for penetration and diffusion of the drug molecules. Layer-by-layer self-assembled drug-containing nanobubbles on the surfaces of microneedles trigger active drug release upon application of ultrasound. The concomitant microstreaming caused by cavitation effects facilitates the penetration and diffusion of drug molecules in the gelatin gel model and the ex vivo porcine skin model. The proposed drug delivery strategy holds great promise for rapid transdermal drug delivery with enhanced penetration and diffusion of the released drugs.
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Affiliation(s)
- Shengpei Shao
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Siyu Wang
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Lili Ren
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Jiahui Wang
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Xinmeng Chen
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Hequn Pi
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Yongjing Sun
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Chen Dong
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Lixing Weng
- School of Geography and Biological Information, Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Yu Gao
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
| | - Lianhui Wang
- State Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Jiangsu National Synergistic Innovation Center for Advanced Materials (SICAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
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4
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Lee JS, Yoon S, Han SJ, Kim ED, Kim J, Shin HS, Seo KY. Eyedrop vaccination: an immunization route with promises for effective responses to pandemics. Expert Rev Vaccines 2021; 21:91-101. [PMID: 34788181 DOI: 10.1080/14760584.2022.2008246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Mucosal vaccines have several advantages over parenteral vaccines. They induce both systemic and mucosal antigen-specific immune responses, allow easy administration, and bypass the need for trained medical personnel. AREAS COVERED Eye mucosa is a novel route of mucosal vaccine administration. Eyedrop vaccination induces systemic and mucosal immune responses similar to other forms of mucosal vaccines such as oral and intranasal vaccines. EXPERT OPINION Eyedrop vaccines are free of serious adverse side effects like the infiltration of CNS by pathogens. Studies over the years have shown promising results for eye drop vaccines against infectious agents like the influenza virus, Salmonella typhi, and Escherichia coli in animal models. Such efficacy and safety of eyedrop vaccination enable the application of eyedrop vaccines against other infectious diseases as well as chronic diseases. In this review of published literature, we examine the mechanism, efficacy, and safety of eyedrop vaccines and contemplate their role in times of a pandemic.
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Affiliation(s)
- Jihei Sara Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sangchul Yoon
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.,Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, South Korea
| | - Soo Jung Han
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Do Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Jiyeon Kim
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Hae-Sol Shin
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.,Korea Mouse Sensory Phenotyping Center (Kmspc), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.,Korea Mouse Sensory Phenotyping Center (Kmspc), Yonsei University College of Medicine, Seoul, Republic of Korea
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Weld ED, Astemborski J, Kirk GD, Sulkowski MS, Stephanie K, Rothman R, Solomon SS, Matthews GV, Hsieh YH, Verma M, Traverso G, Swindells S, Owen A, Feld J, Flexner C, Mehta SH, Thomas DL. Preferences of Persons with or at Risk for Hepatitis C for Long-Acting Treatments. Clin Infect Dis 2021; 75:3-10. [PMID: 34699587 DOI: 10.1093/cid/ciab913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Whereas safe, curative treatments for hepatitis C virus (HCV) have been available since 2015, there are still 58 million infected persons worldwide, and global elimination may require new paradigms. We sought to understand the acceptability of long-acting HCV treatment approaches. METHODS A cross-sectional, 43-question survey was administered to 1457 individuals with HCV or at risk of HCV at 28 sites in 9 countries to assess comparative interest in a variety of long-acting strategies in comparison to oral pills. RESULTS Among HCV-positive participants, 37.7% most preferred an injection, 5.6% an implant, and 6% a gastric residence device, as compared to 50.8% who stated they would most prefer taking 1 to 3 pills per day. When compared directly to taking pills, differences were observed in the relative preference for an injection based on age (p<0.001), location (p<0.001), and prior receipt of HCV treatment (p=0.005), but not sex. When an implant was compared to pills, greater preference was represented by women (p=0.01) and adults of younger ages (p=0.012 per 5 years). Among participants without HCV, 49.5% felt that injections are stronger than pills, and 34.7% preferred taking injections to pills. Among those at-risk participants who had received injectable medications in the past, 123 out of 137 (89.8%) expressed willingness to receive one in the future. CONCLUSIONS These data point to high acceptability of long-acting treatments, which for a substantial minority, might even be preferred to pills for the treatment of HCV infection. Long-acting treatments for HCV infection might contribute to global efforts to eliminate hepatitis C.
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Affiliation(s)
- Ethel D Weld
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacqueline Astemborski
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Division of Infectious Disease Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark S Sulkowski
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katz Stephanie
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Rothman
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Swindells
- Department of Internal Medicine, Section of Infectious Diseases, The University of Nebraska Medical Center, Omaha, NE, USA
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Jordan Feld
- The Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Charles Flexner
- Department of Medicine, Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Division of Infectious Disease Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L Thomas
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Hepatitis B virus genotypes in Brazil: Introduction and dissemination. INFECTION GENETICS AND EVOLUTION 2021; 93:104936. [PMID: 34023512 DOI: 10.1016/j.meegid.2021.104936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Hepatitis B is a viral infectious disease highly spread worldwide with a long evolutionary history associated with human migrations through the continents and countries. Hepatitis B virus (HBV) was disseminated probably from Africa and diverged into ten genotypes (HBV-A to HBV-J) distributed around the world. In Brazil, almost all HBV genotypes were already reported, with a predominance of three ones: A (52.1%), D (36.8%), and F (7.7%). This review aimed to evaluate the introduction and dissemination of the main HBV genotypes and subgenotypes in Brazil over the last centuries to explain the current epidemic scenario. The highest frequency of HBV-A is a consequence of the introduction and spreading of HBV-A1 in the 16th to 19th centuries due to the African slave trade, but the more recent introduction of HBV-A2 from Europe also contributed to the current situation. HBV-D is the second most frequent genotype because it was consecutively introduced by migrations from Europe (mainly subgenotype D3, but also D2) and the Middle East (D1) in the 19th to 20th centuries. On contrary, HBV-F (F1a, F1b, F2a, F2b, F3, and F4) was disseminated by the Amerindians in all South American countries, including Brazil, by migrations inside the continent for more than three centuries ago. Other HBV genotypes are rare and eventually frequent in some human groups because of the dissemination by very specific epidemiological routes. In conclusion, the current scenario of the HBV epidemics is a consequence of the introduction and dissemination of some subgenotypes from the three main genotypes A, D, and F over the last five centuries.
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Lopez-Ramirez MA, Kupor D, Marchiori L, Soto F, Rueda R, Reynoso M, Narra LR, Chakravarthy K, Wang J. Combinatorial microneedle patch with tunable release kinetics and dual fast-deep/sustained release capabilities. J Mater Chem B 2021; 9:2189-2199. [PMID: 33651048 DOI: 10.1039/d1tb00141h] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Transdermal microneedle (MN) drug delivery patches, comprising water-soluble polymers, have played an essential role in diverse biomedical applications, but with limited development towards fast deep release or sustained delivery applications. The effectiveness of such MN delivery patches strongly depends on the materials from which they are constructed. Herein, we present a dual-action combinatorial programmable MN patch, comprising of fast and sustained-release MN zones, with tunable release kinetics towards delivering a wide range of therapeutics over different timeframes in single application. We demonstrate the fine tuning of MN materials; the patches can be tailored to deliver a first payload faster and deeper within minutes, while simultaneously delivering a second payload over long times ranging from weeks to months. The active and rapid burst release relies on embedding biodegradable Mg microparticle 'engines' in dissolvable MNs while the sustained release is attributed to biocompatible polymers that allow prolonged release in a controllable tunable manner. In addition, the patches are characterized and optimized for their design, materials and mechanical properties. These studies indicate that such programmable dual-action versatile MN platform is expected to improve therapeutic efficacy and patient compliance, achieving powerful benefits by single patch application at low manufacturing cost.
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Affiliation(s)
| | - Daniel Kupor
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA.
| | - Leonardo Marchiori
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA.
| | - Fernando Soto
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA.
| | - Ricardo Rueda
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA.
| | - Maria Reynoso
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA.
| | - Lakshmi Rekha Narra
- Department of Anesthesiology and Pain Medicine, University of California, San Diego, Health Sciences, La Jolla, California 92093, USA
| | - Krishnan Chakravarthy
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA. and Department of Anesthesiology and Pain Medicine, University of California, San Diego, Health Sciences, La Jolla, California 92093, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093, USA.
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Ingasia LAO, Kostaki EG, Paraskevis D, Kramvis A. Global and regional dispersal patterns of hepatitis B virus genotype E from and in Africa: A full-genome molecular analysis. PLoS One 2020; 15:e0240375. [PMID: 33031453 PMCID: PMC7544117 DOI: 10.1371/journal.pone.0240375] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
Description of the spatial characteristics of viral dispersal is important in understanding the history of infections. Nine hepatitis B virus (HBV) genotypes (A-I), and a putative 10th genotype (J), with distinct geographical distribution, are recognized. In sub-Saharan Africa (sub)-genotypes A1, D3 and E circulate, with E predominating in western Africa (WA), where HBV is hyperendemic. The low genetic diversity of genotype E (HBV/E) suggests its recent emergence. Our aim was to study the dispersal of HBV/E using full-length, non-redundant and non-recombinant sequences available in public databases. HBV/E was confirmed, and the phylogeny reconstruction performed using maximum likelihood (ML) with bootstrapping. Phylogeographic analysis was conducted by reconstruction of ancestral states using the criterion of parsimony on the estimated ML phylogeny. 46.5% of HBV/E sequences were found within monophyletic clusters. Country-wise analysis revealed the existence of 50 regional clusters. Sequences from WA were located close to the root of the tree, indicating this region as the most probable origin of the HBV/E epidemic and expanded to other geographical regions, within and outside of Africa. A localized dispersal was observed with sequences from Nigeria and Guinea as compared to other WA countries. Based on the sequences available in the databases, the phylogenetic results suggest that European strains originated primarily from WA whereas a majority of American strains originated in Western Central Africa. The differences in regional dispersal patterns of HBV/E suggest limited cross-border transmissions because of restricted population movements.
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Affiliation(s)
- Luicer Anne Olubayo Ingasia
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Frew PM, Paine MB, Rouphael N, Schamel J, Chung Y, Mulligan MJ, Prausnitz MR. Acceptability of an inactivated influenza vaccine delivered by microneedle patch: Results from a phase I clinical trial of safety, reactogenicity, and immunogenicity. Vaccine 2020; 38:7175-7181. [PMID: 32792250 DOI: 10.1016/j.vaccine.2020.07.064] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to evaluate the acceptability of inactivated influenza vaccine delivered by microneedle patch (MNP) in comparison to inactivated influenza vaccine (IIV) delivered by hypodermic needle. DESIGN, SETTING, AND PARTICIPANTS From the general population of Atlanta, Georgia, we screened 112 and enrolled 100 healthy adult subjects ages 18 to 49 years. Main Outcome(s) and Measure(s). Our participants were randomized to 4 groups of 25 per arm: (1) IIV by MNP administered by healthcare worker (HCW), (2) IIV by MNP self-administered by study participants, (3) IIV by intramuscular (IM) injection administered by HCW or (4) placebo by MNP administered by HCW. We administered four questionnaires: at Day 0 before and after study product delivery, and at Days 8 and 28. RESULTS At baseline, 98.6% of participants receiving MNP vaccination reported an overall positive experience with MNPs, compared to 86.4% for participants receiving IM vaccination. For future influenza vaccination, study participants (N = 99) preferred MNP (n = 65, 69.9%) to injections or nasal spray (n = 20, 21.5%), and the preference for MNP increased from Day 0 to Day 28. Factor analyses resulted in two scaled measures including MNP Use Perceptions (a = 0.799, n = 5 items) and MNP Perceived Convenience (a = 0.844, n = 4 items) that were included in longitudinal assessments; while findings reflect significant differences across treatment groups on mean scores for ease of use, MNP perceived protection, MNP reliability, and MNP selection knowledge, all groups reported their belief that influenza vaccination by MNP would be reliable and protective, as well as easy-to-use and convenient. CONCLUSIONS AND RELEVANCE Most participants were accepting of IIV vaccination by MNP and preferred it to injection. Delivery of IIV by MNP may help increase vaccination coverage.
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Affiliation(s)
- Paula M Frew
- The University of Nevada, Las Vegas, School of Public Health, United States; UNLV Population Health & Health Equity Initiative, United States.
| | - Michele Bennett Paine
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States; The Hope Clinic of the Emory Vaccine Center, United States
| | - Nadine Rouphael
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States; The Hope Clinic of the Emory Vaccine Center, United States
| | - Jay Schamel
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Yunmi Chung
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Mark J Mulligan
- NYU Langone Health, Division of Infectious Diseases and Immunology, United States
| | - Mark R Prausnitz
- Georgia Institute of Technology, School of Chemical and Biomolecular Engineering, United States
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10
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Na YG, Kim M, Han M, Huh HW, Kim JS, Kim JC, Park JH, Lee HK, Cho CW. Characterization of Hepatitis B Surface Antigen Loaded Polylactic Acid-Based Microneedle and Its Dermal Safety Profile. Pharmaceutics 2020; 12:pharmaceutics12060531. [PMID: 32527003 PMCID: PMC7355901 DOI: 10.3390/pharmaceutics12060531] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
A surge of interest in microneedle (MN) vaccines as a novel vaccination system has emerged. Before the clinical application of MN vaccine, an assessment of potential biological risks to skin and quality control of MN must be performed. Therefore, the present study aims to evaluate the physicochemical properties of MN and to evaluate the histological changes and inflammatory cell infiltrations after the application of MN with hepatitis B surface antigen (HBsAg). During in vitro and in vivo release testing, HBsAg MN released over 70% of HBsAg at 30 min. During the pyrogen test of HBsAg MN in rabbit, no rabbit showed an individual rise in temperature of 0.5 °C or more. MN with HBsAg produced the moderate immunization in mice. MN application did not alter the thickness of dermal and epidermal layers in mice. In addition, the topical applications of MN and MN for hepatitis B vaccine did not acutely induce the inflammation, allergic reaction, dermal toxicity and skin irritation. Thus, the MN system for the delivery of HBsAg could be the promising technology in the hepatitis B vaccination.
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Affiliation(s)
- Young-Guk Na
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (Y.-G.N.); (M.K.); (M.H.); (H.W.H.)
| | - Minki Kim
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (Y.-G.N.); (M.K.); (M.H.); (H.W.H.)
| | - Mingu Han
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (Y.-G.N.); (M.K.); (M.H.); (H.W.H.)
| | - Hyun Wook Huh
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (Y.-G.N.); (M.K.); (M.H.); (H.W.H.)
| | - Ji-Seok Kim
- Department of BioNano Technology and Gachon BioNano Research Institute, Gachon University, Seongnam 13120, Korea; (J.-S.K.); (J.C.K.); (J.-H.P.)
| | - Jong Chan Kim
- Department of BioNano Technology and Gachon BioNano Research Institute, Gachon University, Seongnam 13120, Korea; (J.-S.K.); (J.C.K.); (J.-H.P.)
| | - Jung-Hwan Park
- Department of BioNano Technology and Gachon BioNano Research Institute, Gachon University, Seongnam 13120, Korea; (J.-S.K.); (J.C.K.); (J.-H.P.)
| | - Hong-Ki Lee
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (Y.-G.N.); (M.K.); (M.H.); (H.W.H.)
- Correspondence: (H.-K.L.); (C.-W.C.); Tel.: +82-42-821-7301 (H.-K.L.); +82-42-821-5934 (C.-W.C.); Fax: +82-42-823-6566 (H.-K.L.); +82-42-823-6566 (C.-W.C.)
| | - Cheong-Weon Cho
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (Y.-G.N.); (M.K.); (M.H.); (H.W.H.)
- Correspondence: (H.-K.L.); (C.-W.C.); Tel.: +82-42-821-7301 (H.-K.L.); +82-42-821-5934 (C.-W.C.); Fax: +82-42-823-6566 (H.-K.L.); +82-42-823-6566 (C.-W.C.)
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11
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Lopez-Ramirez MA, Soto F, Wang C, Rueda R, Shukla S, Silva-Lopez C, Kupor D, McBride DA, Pokorski JK, Nourhani A, Steinmetz NF, Shah NJ, Wang J. Built-In Active Microneedle Patch with Enhanced Autonomous Drug Delivery. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1905740. [PMID: 31682039 PMCID: PMC7014935 DOI: 10.1002/adma.201905740] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/09/2019] [Indexed: 05/08/2023]
Abstract
The use of microneedles has facilitated the painless localized delivery of drugs across the skin. However, their efficacy has been limited by slow diffusion of molecules and often requires external triggers. Herein, an autonomous and degradable, active microneedle delivery platform is introduced, employing magnesium microparticles loaded within the microneedle patch, as the built-in engine for deeper and faster intradermal payload delivery. The magnesium particles react with the interstitial fluid, leading to an explosive-like rapid production of H2 bubbles, providing the necessary force to breach dermal barriers and enhance payload delivery. The release kinetics of active microneedles is evaluated in vitro by measuring the amount of IgG antibody (as a model drug) that passed through phantom tissue and a pigskin barrier. In vivo experiments using a B16F10 mouse melanoma model demonstrate that the active delivery of anti-CTLA-4 (a checkpoint inhibitor drug) results in greatly enhanced immune response and significantly longer survival. Moreover, spatially resolved zones of active and passive microneedles allow a combinatorial rapid burst response along with slow, sustained release, respectively. Such versatile and effective autonomous dynamic microneedle delivery technology offers considerable promise for a wide range of therapeutic applications, toward a greatly enhanced outcome, convenience, and cost.
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Affiliation(s)
| | - Fernando Soto
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Chao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ricardo Rueda
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Sourabh Shukla
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Cristian Silva-Lopez
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Daniel Kupor
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - David A McBride
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
- Chemical Engineering Program, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Jonathan K Pokorski
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
- Center for Nano-Immunoengineering, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Amir Nourhani
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Nicole F Steinmetz
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
- Center for Nano-Immunoengineering, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
- Department of Radiology, University of California, San Diego, La Jolla, San Diego, CA, 92093, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Nisarg J Shah
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
- Chemical Engineering Program, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
- Center for Nano-Immunoengineering, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
- Program in Immunology, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093, USA
- Center for Nano-Immunoengineering, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
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12
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Cotton MF, Rabie H. HIV outbreak in children in Pakistan: localised or more widespread? THE LANCET. INFECTIOUS DISEASES 2019; 20:269-270. [PMID: 31866330 DOI: 10.1016/s1473-3099(19)30746-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Mark F Cotton
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; Department of Paediatrics and Child Health, Tygerberg Hospital, Tygerbeg, South Africa.
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; Department of Paediatrics and Child Health, Tygerberg Hospital, Tygerbeg, South Africa
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13
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Khedhiri M, Ghedira K, Chouikha A, Touzi H, Sadraoui A, Hammemi W, Triki H. Tracing the epidemic history of hepatitis C virus genotype 1b in Tunisia and in the world, using a Bayesian coalescent approach. INFECTION GENETICS AND EVOLUTION 2019; 75:103944. [PMID: 31260787 DOI: 10.1016/j.meegid.2019.103944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Marwa Khedhiri
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Research Laboratory: "Transmission Controle et Immunobiologie des Infections" (LR11-IPT02), Pasteur Institute of Tunis, Tunisia; Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Faculty of Sciences of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Kais Ghedira
- Laboratory of Bioinformatics, Biomathematics and Biostatistics - LR16IPT09, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Anissa Chouikha
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Research Laboratory: "Transmission Controle et Immunobiologie des Infections" (LR11-IPT02), Pasteur Institute of Tunis, Tunisia; Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Henda Touzi
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Amel Sadraoui
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Walid Hammemi
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Research Laboratory: "Transmission Controle et Immunobiologie des Infections" (LR11-IPT02), Pasteur Institute of Tunis, Tunisia; Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
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14
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Wallis J, Shenton DP, Carlisle RC. Novel approaches for the design, delivery and administration of vaccine technologies. Clin Exp Immunol 2019; 196:189-204. [PMID: 30963549 PMCID: PMC6468175 DOI: 10.1111/cei.13287] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 12/20/2022] Open
Abstract
It is easy to argue that vaccine development represents humankind's most important and successful endeavour, such is the impact that vaccination has had on human morbidity and mortality over the last 200 years. During this time the original method of Jenner and Pasteur, i.e. that of injecting live-attenuated or inactivated pathogens, has been developed and supplemented with a wide range of alternative approaches which are now in clinical use or under development. These next-generation technologies have been designed to produce a vaccine that has the effectiveness of the original live-attenuated and inactivated vaccines, but without the associated risks and limitations. Indeed, the method of development has undoubtedly moved away from Pasteur's three Is paradigm (isolate, inactivate, inject) towards an approach of rational design, made possible by improved knowledge of the pathogen-host interaction and the mechanisms of the immune system. These novel vaccines have explored methods for targeted delivery of antigenic material, as well as for the control of release profiles, so that dosing regimens can be matched to the time-lines of immune system stimulation and the realities of health-care delivery in dispersed populations. The methods by which vaccines are administered are also the subject of intense research in the hope that needle and syringe dosing, with all its associated issues regarding risk of injury, cross-infection and patient compliance, can be replaced. This review provides a detailed overview of new vaccine vectors as well as information pertaining to the novel delivery platforms under development.
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Affiliation(s)
- J. Wallis
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
| | - D. P. Shenton
- Defence Science and Technology LaboratoryPorton DownUK
| | - R. C. Carlisle
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
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15
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Abstract
Molecular studies suggest that HIV arose in Africa between 1880 and 1940. During this period, there were campaigns by European colonial governments that involved unsterile injections of large numbers of Africans. That, along with other unsafe therapeutic interventions, may have propelled the evolution of HIV from SIV. Since subtype B in Africa may have been concentrated in white African homosexuals, it is possible that Westerners rather than Haitians introduced the virus to the New World. Amplification of HIV subtype B took place in Haiti, where transmission was facilitated by hazardous medical procedures including plasmapheresis. Representations in the media, however, largely ignore Western contributions to the spread of AIDS. This article focuses on the value of alternative narratives in fostering a balanced view that is less stigmatizing on developing nations.
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Affiliation(s)
- Michael A. Vance
- College of Pharmacy and Health Sciences, Butler University, Indianapolis,
IN, USA
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16
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Maniar JK. Horizontal transmission of HIV-1 infection in a child: With phylodynamic evidence-case study. Indian J Sex Transm Dis AIDS 2019; 40:73-76. [PMID: 31143866 PMCID: PMC6532492 DOI: 10.4103/ijstd.ijstd_4_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Mother-to-child transmission is the predominant mode of transmission of HIV infection in children. Occasionally, horizontal transmission has also been reported. We report a child who was diagnosed HIV positive at the age of 3.5 years born to HIV-negative mother. Based on the available histories, no alternative modes of HIV transmission could be implicated. However, the paternal grandmother of the child was found to be HIV infected. To explore the likelihood that this HIV-infected relative was the most likely source from which this child acquired HIV infection postnatally, Bayesian phylodynamic analysis of the HIV of the child and parental grandmother was performed, which showed evidence of linkage of HIV transmission from an HIV-infected paternal grandmother to a child living with her through unknown route. Studies to identify modes of nonvertical HIV transmission may be useful in devising strategies to avert such nonvertical infections.
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Affiliation(s)
- Janak Keshavlal Maniar
- Department of Infectious Diseases and HIV Medicine, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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17
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Rodgers MA, Holzmayer V, Vallari A, Olivo A, Forberg K, Fuhrman J, Coller KE, Awazi B, Kenmegne Sidje JB, Frankel MB, Berg MG, Mbanya D, Ndembi N, Cloherty GA. Hepatitis C virus surveillance and identification of human pegivirus 2 in a large Cameroonian cohort. J Viral Hepat 2019; 26:30-37. [PMID: 30187640 PMCID: PMC7379692 DOI: 10.1111/jvh.12996] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022]
Abstract
The prevalence of chronic hepatitis C virus (HCV) and the presence of human pegivirus 2 (HPgV-2) have not been examined in Cameroon, although HCV has been associated with HPgV-2 infections previously. Herein we aimed to characterize the burden and genetic diversity of HCV and the presence of HPgV-2 in Cameroon. Retrospective plasma specimens collected from N = 12 369 consenting subjects in South Cameroon from 2013 to 2016 were included in the study. The majority (97.1%) of participants were patients seeking health care. All specimens were screened for HCV using the Abbott RealTime HCV viral load assay and positive specimens with remaining volume were also screened for HPgV-2 antibodies on the Abbott ARCHITECT instrument, followed by molecular characterization. Overall, HCV RNA was detected in 305 (2.47%; 95% CI: 2.21%-2.75%) specimens. Notably, the prevalence of HCV RNA was 9.09% amongst participants over age 40 and 3.81% amongst males. Phylogenetic classification of N = 103 HCV sequences identified genotypes 1 (19.4%), 2 (15.5%) and 4 (65.1%) within the study cohort. Amongst HCV RNA-positive specimens, N = 28 (10.6%; 95% CI: 7.44%-14.90%) specimens also had detectable HPgV-2 antibodies. Of these, N = 2 viremic HPgV-2 infections were confirmed by sequencing and shared 93-94 median % identity with strains found on other continents. This is the first study to determine the prevalence of chronic HCV in Cameroon, and the discovery of HPgV-2 in this study cohort expands the geography of HPgV-2 to the African continent, indicating a widespread distribution exists.
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Affiliation(s)
| | | | | | - Ana Olivo
- Abbott LaboratoriesAbbott ParkIllinoisUSA
| | | | | | | | - Bih Awazi
- Université de Yaoundé IYaoundéCameroon
| | | | | | | | - Dora Mbanya
- Université de Yaoundé IYaoundéCameroon,University of BamendaBamendaCameroon
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18
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Liu CR, Li X, Chan PL, Zhuang H, Jia JD, Wang X, Lo YR, Walsh N. Prevalence of hepatitis C virus infection among key populations in China: A systematic review. Int J Infect Dis 2018; 80:16-27. [PMID: 30529371 DOI: 10.1016/j.ijid.2018.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND AIM Chronic hepatitis C is a major global health challenge. China has the world's largest burden of hepatitis C and related liver disease, with several groups having an increased risk of acquiring hepatitis C virus (HCV) infection. We undertook a systematic review in Chinese and English literature to determine the seroprevalence of anti-HCV among men who have sex with men (MSM), sex workers, people who use drugs (PWUD) and migrant workers in China. METHODS We searched three Chinese databases (CNKI, Wanfang and Chongqing VIP Information) and four English databases (Pubmed, EMBASE, Global Health and CINAHL) for studies published between 2010 and 2015. Included were 89 studies for MSM, 112 for sex workers, 11 for migrant workers, 94 for people who inject drugs (PWID) and 67 for non-injectors. Random-effect models pooled estimates of anti-HCV seroprevalence in each population and a meta-regression model examined the relationship between anti-HCV seroprevalence and injecting drug use. RESULTS The overall pooled seroprevalence of anti-HCV among MSM was 0.67% (CI 95 0.51-0.86); for sex workers 0.65% (CI 95 0.53-0.77); for migrant workers 0.48 (CI 95 0.20-0.85); for IDUs 72.41% (CI 95 68.71-75.97); among non-injectors 25.07% (CI 95 21.51%-28.80%). Our meta-regression model predicted that the seroprevalence of anti-HCV among PWID increased by 8.6% for each 10% increase seroprevalence of reporting ever having injected drugs. CONCLUSIONS Overall, seroprevalence of HCV infection is high among PWUD, especially those who inject. Lower HCV seroprevalence (<1%) was found among MSM, sex workers and migrant workers. Our estimates for IDU seroprevalence are higher than that from the national surveillance system, though estimates for other at-risk populations are similar.
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Affiliation(s)
- Che-Rung Liu
- Division of Communicable Diseases, World Health Organization Regional Office for the Western Pacific, Philippines
| | - Xi Li
- Division of Communicable Diseases, World Health Organization Regional Office for the Western Pacific, Philippines
| | - Po-Lin Chan
- Division of Communicable Diseases, World Health Organization Regional Office for the Western Pacific, Philippines
| | - Hui Zhuang
- Department of Microbiology, Peking University Health Science Center, Beijing, China
| | - Ji-Dong Jia
- Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Xiaochun Wang
- Department of Hepatitis C and STD Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying-Ru Lo
- Division of Communicable Diseases, World Health Organization Regional Office for the Western Pacific, Philippines
| | - Nick Walsh
- Division of Communicable Diseases, World Health Organization Regional Office for the Western Pacific, Philippines.
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19
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Alves K, Godwin CL, Chen A, Akellot D, Katz JN, Sabatini CS. Gluteal fibrosis, post-injection paralysis, and related injection practices in Uganda: a qualitative analysis. BMC Health Serv Res 2018; 18:892. [PMID: 30477506 PMCID: PMC6258157 DOI: 10.1186/s12913-018-3711-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/14/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Iatrogenic injection injury is a major cause of disability in Ugandan children. Two injuries thought to result from injection of medications into the gluteal region include post-injection paralysis (PIP) and gluteal fibrosis (GF). This study aimed to describe perceptions of local health care workers regarding risk factors, particularly injections, for development of GF and PIP. Specifically, we examine the role of injection practices in the development of these injuries by interviewing a diverse cohort of individuals working in the health sector. METHODS We conducted a qualitative study in the Kumi and Wakiso Districts of Uganda in November 2017, utilizing 68 key informant interviews with individuals working in healthcare related fields. Interviews were structured utilizing a moderator guide focusing on injection practices, gluteal fibrosis and post-injection paralysis. RESULTS We identified six themes regarding perceptions of the cause of GF and PIP and organized these themes into a theoretical framework. There was a consensus among the individuals working in healthcare that inadequacies of the health care delivery system may lead to inappropriate intramuscular injection practices, which are presumed to contribute to the development of GF and PIP. Poor access to medications and qualified personnel has led to the proliferation of private clinics, which are often staffed by under-trained practitioners. Misaligned economic incentives and a lack of training may also motivate practitioners to administer frequent intramuscular injections, which cost more than oral medications. A lack of regulatory enforcement enables these practices to persist. However, due to limited community awareness, patients often perceive these practitioners as appropriately trained, and the patients frequently prefer injections over alternative treatment modalities. CONCLUSION This qualitative study suggests that inappropriate intramuscular injections, may arise from problems in the health care delivery system. To prevent the disability of GF and PIP, it is important to not only address the intramuscular injections practices in Uganda, but also to examine upstream deficits in access, education, and policy enforcement.
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Affiliation(s)
- Kristin Alves
- Harvard Combined Orthopaedic Surgery Residency Program, 75 Francis Street, Boston, MA BTM 02115 USA
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Boston, MA USA
| | | | - Angela Chen
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Boston, MA USA
| | | | - Jeffrey N. Katz
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Boston, MA USA
| | - Coleen S. Sabatini
- Department of Orthopaedic Surgery, University of California San Francisco and UCSF Benioff Children’s Hospital Oakland, Oakland, CA USA
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20
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Zheng Z, Diaz-Arévalo D, Guan H, Zeng M. Noninvasive vaccination against infectious diseases. Hum Vaccin Immunother 2018; 14:1717-1733. [PMID: 29624470 PMCID: PMC6067898 DOI: 10.1080/21645515.2018.1461296] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The development of a successful vaccine, which should elicit a combination of humoral and cellular responses to control or prevent infections, is the first step in protecting against infectious diseases. A vaccine may protect against bacterial, fungal, parasitic, or viral infections in animal models, but to be effective in humans there are some issues that should be considered, such as the adjuvant, the route of vaccination, and the antigen-carrier system. While almost all licensed vaccines are injected such that inoculation is by far the most commonly used method, injection has several potential disadvantages, including pain, cross contamination, needlestick injury, under- or overdosing, and increased cost. It is also problematic for patients from rural areas of developing countries, who must travel to a hospital for vaccine administration. Noninvasive immunizations, including oral, intranasal, and transcutaneous administration of vaccines, can reduce or eliminate pain, reduce the cost of vaccinations, and increase their safety. Several preclinical and clinical studies as well as experience with licensed vaccines have demonstrated that noninvasive vaccine immunization activates cellular and humoral immunity, which protect against pathogen infections. Here we review the development of noninvasive immunization with vaccines based on live attenuated virus, recombinant adenovirus, inactivated virus, viral subunits, virus-like particles, DNA, RNA, and antigen expression in rice in preclinical and clinical studies. We predict that noninvasive vaccine administration will be more widely applied in the clinic in the near future.
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Affiliation(s)
- Zhichao Zheng
- a Key Laboratory of Oral Medicine , Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China.,b Center of Emphasis in Infectious Diseases , Department of Biomedical Sciences , Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso , El Paso , Texas , USA
| | - Diana Diaz-Arévalo
- c Grupo Funcional de Inmunología , Fundación Instituto de Inmunología de Colombia-FIDIC, Faculty of Agricultural Sciences, Universidad de Ciencias Aplicadas y Ambientales U.D.C.A, School of Medicine and Health Sciences, Universidad del Rosario , Bogotá , DC . Colombia
| | - Hongbing Guan
- a Key Laboratory of Oral Medicine , Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Mingtao Zeng
- a Key Laboratory of Oral Medicine , Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China.,b Center of Emphasis in Infectious Diseases , Department of Biomedical Sciences , Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso , El Paso , Texas , USA
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21
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Abstract
Over the course of the twentieth century, as hospitals cleaned up, they came to produce more and more rubbish. Beginning in the 1970s and gaining pace in the 1980s and 1990s, single-use plastic items (syringes, blood bags, tubing) saturated everyday medical practice across the globe. This essay brings the question of plastic to bear upon the longer history of twentieth century sanitary science. The widespread adoption of single-use disposable medical plastics consolidated a century's worth of changes in medical hygiene. As strange as it may seem today, the initial uptake of medical plastics was not driven primarily by concerns about hygiene. Plastic began as a mid-century technology of convenience and durability. It was not until the end of the twentieth century that it morphed into a powerful symbol and instrument of medical hygiene. Today, both patients and practitioners have embraced plastic as an indispensable technology of clean medicine. The procession of single-use medical plastics through everyday medicine now comprises a constant, if disposable, infrastructure of medical hygiene. This new processional infrastructure of disposable hygiene has produced another, albeit unintended, consequence. This new regime has exponentially increased hospitals' material outputs. In so doing, plastic has refigured the ecologies of everyday medicine. Plastic hygiene has rendered hospitals factories of medical garbage.
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Affiliation(s)
- Sarah Hodges
- a History Department , University of Warwick , Coventry , UK
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22
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23
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Gürtler LG, Eberle J. Aspects on the history of transmission and favor of distribution of viruses by iatrogenic action: perhaps an example of a paradigm of the worldwide spread of HIV. Med Microbiol Immunol 2017; 206:287-293. [PMID: 28434128 PMCID: PMC5511299 DOI: 10.1007/s00430-017-0505-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
Transmission of infectious agents might be associated with iatrogenic actions of charitable help in health care. An example is the vaccination against yellow fever in USA that transmitted hepatitis B virus. Another example is injections of praziquantel for treatment and cure of schistosomiasis in Central and Northern Africa, with a focus in Egypt that has spread hepatitis C virus. There is no indication that human T-lymphotropic virus type 1 was spread by injection treatment for African trypanosomiasis, syphilis and treponematosis, but these treatments might have contributed to the early spread of human immunodeficiency virus type 1 (HIV-1) in Central Africa. Slave trade contributed as well to the spread of viruses from Africa to the Americas; it was stopped in 1850. Until that date HIV-1 was not transported to the Americas. By analysis of nucleic acid sequence data it can be concluded that the continental spread of HCV and HIV-1 might have started around 1920 with an exponential phase from 1940 to 1970. Further iatrogenic actions that promoted the spread of HCV and HIV-1 might be vaccinations to prevent deadly diseases. The successful vaccination was followed by diminution of the infectious agent in the population such as small pox, yellow fever and measles. Measurements to reduce the spread of plague and cholera were further benefits increasing survival of diseased subjects in a population. Thus, the reduction of exposure to deadly infectious agents might have given a chance to HIV-1 infected subjects to survive and for HIV-1 to be distributed around the world starting from Central Africa in the 1950s.
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Affiliation(s)
- Lutz G. Gürtler
- Max von Pettenkofer Institute, National Reference Centre for Retroviruses, Ludwig-Maximilians-University of München, Pettenkofer Str 9A, 80336 Munich, Germany
| | - Josef Eberle
- Max von Pettenkofer Institute, National Reference Centre for Retroviruses, Ludwig-Maximilians-University of München, Pettenkofer Str 9A, 80336 Munich, Germany
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Rodrigo C, Eltahla AA, Bull RA, Grebely J, Dore GJ, Applegate T, Page K, Bruneau J, Morris MD, Cox AL, Osburn W, Kim AY, Schinkel J, Shoukry NH, Lauer GM, Maher L, Hellard M, Prins M, Estes C, Razavi H, Lloyd AR, Luciani F. Historical Trends in the Hepatitis C Virus Epidemics in North America and Australia. J Infect Dis 2016; 214:1383-1389. [PMID: 27571901 DOI: 10.1093/infdis/jiw389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/15/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Bayesian evolutionary analysis (coalescent analysis) based on genetic sequences has been used to describe the origins and spread of rapidly mutating RNA viruses, such as influenza, Ebola, human immunodeficiency virus (HIV), and hepatitis C virus (HCV). METHODS Full-length subtype 1a and 3a sequences from early HCV infections from the International Collaborative of Incident HIV and Hepatitis C in Injecting Cohorts (InC3), as well as from public databases from a time window of 1977-2012, were used in a coalescent analysis with BEAST software to estimate the origin and progression of the HCV epidemics in Australia and North America. Convergent temporal trends were sought via independent epidemiological modeling. RESULTS The epidemic of subtype 3a had more recent origins (around 1950) than subtype 1a (around 1920) in both continents. In both modeling approaches and in both continents, the epidemics underwent exponential growth between 1955 and 1975, which then stabilized in the late 20th century. CONCLUSIONS Historical events that fuelled the emergence and spread of injecting drug use, such as the advent of intravenous medical therapies and devices, and growth in the heroin trade, as well as population mixing during armed conflicts, were likely drivers for the cross-continental spread of the HCV epidemics.
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Affiliation(s)
| | | | | | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | - Tanya Applegate
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | | | | | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - William Osburn
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | | | - Janke Schinkel
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam, Academic Medical Center, Meibergdreef
| | | | | | - Lisa Maher
- The Kirby Institute, UNSW Australia, Sydney, New South Wales
| | | | - Maria Prins
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam, Academic Medical Center, Meibergdreef.,GGD Public Health Service of Amsterdam, The Netherlands
| | - Chris Estes
- Center for Disease Analysis, Louisville, Colorado
| | - Homie Razavi
- Center for Disease Analysis, Louisville, Colorado
| | - Andrew R Lloyd
- School of Medical Sciences, Faculty of Medicine.,The Kirby Institute, UNSW Australia, Sydney, New South Wales
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Frost SDW, Kwofie SK. Surveys, Serologies, and Sequences Reveal History of Iatrogenic Transmission of HIV-1. J Infect Dis 2016; 214:341-3. [PMID: 26768255 PMCID: PMC7107339 DOI: 10.1093/infdis/jiw012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Simon D W Frost
- Department of Veterinary Medicine Institute of Public Health, University of Cambridge, United Kingdom
| | - Samuel K Kwofie
- Department of Veterinary Medicine Biomedical Engineering Department, University of Ghana, Legon
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Hogan CA, Iles J, Frost EH, Giroux G, Cassar O, Gessain A, Dion MJ, Ilunga V, Rambaut A, Yengo-Ki-Ngimbi AÉ, Behets F, Pybus OG, Pépin J. Epidemic History and Iatrogenic Transmission of Blood-borne Viruses in Mid-20th Century Kinshasa. J Infect Dis 2016; 214:353-60. [PMID: 26768251 DOI: 10.1093/infdis/jiw009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The human immunodeficiency virus type 1 (HIV-1) pandemic was ignited in Léopoldville (now known as Kinshasa), in the former Belgian Congo. Factors that jump-started its early expansion remain unclear. Nonlethal hepatitis C virus (HCV) and human T-cell lymphotropic virus (HTLV-1) can be used to investigate past iatrogenic transmission. METHODS We undertook a cross-sectional study of elderly inhabitants of Kinshasa, with serological assays, amplification, and sequencing. Risk factors were assessed through logistic regression. Phylogenetic methods reconstructed the genetic history of HCV. RESULTS A total of 217 of 839 participants (25.9%) were HCV seropositive; 26 (3.1%) were HTLV-1-seropositive. Amplification products were obtained from 118 HCV-seropositive participants; subtypes 4k (in 47 participants) and 4r (in 38) were most common. Independent risk factors for HCV subtype 4r seropositivity were intramuscular tuberculosis therapy, intravenous injections at hospital A, intravenous injections before 1960, and injections at a colonial-era venereology clinic. Intravenous injections at hospital B and antimalarials were associated with HCV subtype 4k seropositivity. Risk factors for HTLV-1 seropositivity included intravenous injections at hospitals C or D and transfusions. Evolutionary analysis of viral sequences revealed independent exponential amplification of HCV subtypes 4r and 4k from the 1950s onward. CONCLUSIONS Iatrogenic transmission of HCV and HTLV-1 occurred in mid-20th century Kinshasa, at the same time and place HIV-1 emerged. Iatrogenic routes may have contributed to the early establishment of the pandemic.
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Affiliation(s)
| | | | | | | | - Olivier Cassar
- Institut Pasteur Centre National de la Recherche Scientifique, UMR 3569, Paris, France
| | - Antoine Gessain
- Institut Pasteur Centre National de la Recherche Scientifique, UMR 3569, Paris, France
| | | | | | | | | | - Frieda Behets
- Programme ESP/UNC-DRC University of North Carolina, Chapel Hill
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Marshall S, Sahm LJ, Moore AC. The success of microneedle-mediated vaccine delivery into skin. Hum Vaccin Immunother 2016; 12:2975-2983. [PMID: 27050528 DOI: 10.1080/21645515.2016.1171440] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Microneedles (MNs) are designed to specifically target the outermost, skin barrier layer, the stratum corneum, creating transient pathways for minimally invasive transcutaneous delivery. It is reported that MNs can facilitate delivery without stimulating the pain receptors or damaging blood vessels that lie beneath, thus being perceived as painless and associated with reduced bleeding. This immunocompetence of the skin, coupled with its ease of access, makes this organ an attractive vaccination site. The purpose of this review was to collate primary scientific literature pertaining to MN-mediated in vivo vaccination programmes. A total of 62 original research articles are presented, compiling vaccination strategies in 6 different models (mouse, rat, guinea pig, rabbit, pig, macaque and human). Vaccines tested span a wide range of viral, bacterial and protozoan pathogens and includes 7 of the 13 vaccine-preventable diseases, as defined by the WHO. This review highlights the paucity of available clinical trial data. MN-delivered vaccines have demonstrated safety and immunogenicity in pre-clinical models and boast desirable attributes such as painless administration, thermostability, dose-sparing capacity and the potential for self-administration. These advantages should contribute to enhanced global vaccine access.
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Affiliation(s)
- Sarah Marshall
- a School of Pharmacy, University College Cork , Cork , Ireland
| | - Laura J Sahm
- a School of Pharmacy, University College Cork , Cork , Ireland.,b Department of Pharmacy , Mercy University Hospital , Cork , Ireland
| | - Anne C Moore
- a School of Pharmacy, University College Cork , Cork , Ireland.,c Department of Pharmacology and Therapeutics , University College Cork , Cork , Ireland
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Joy JB, McCloskey RM, Nguyen T, Liang RH, Khudyakov Y, Olmstead A, Krajden M, Ward JW, Harrigan PR, Montaner JSG, Poon AFY. The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study. THE LANCET. INFECTIOUS DISEASES 2016; 16:698-702. [PMID: 27039040 DOI: 10.1016/s1473-3099(16)00124-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The timing of the initial spread of hepatitis C virus genotype 1a in North America is controversial. In particular, how and when hepatitis C virus reached extraordinary prevalence in specific demographic groups remains unclear. We quantified, using all available hepatitis C virus sequence data and phylodynamic methods, the timing of the spread of hepatitis C virus genotype 1a in North America. METHODS We screened 45 316 publicly available sequences of hepatitis C virus genotype 1a for location and genotype, and then did phylogenetic analyses of available North American sequences from five hepatitis C virus genes (E1, E2, NS2, NS4B, NS5B), with an emphasis on including as many sequences with early collection dates as possible. We inferred the historical population dynamics of this epidemic for all five gene regions using Bayesian skyline plots. FINDINGS Most of the spread of genotype 1a in North America occurred before 1965, and the hepatitis C virus epidemic has undergone relatively little expansion since then. The effective population size of the North American epidemic stabilised around 1960. These results were robust across all five gene regions analysed, although analyses of each gene separately show substantial variation in estimates of the timing of the early exponential growth, ranging roughly from 1940 for NS2, to 1965 for NS4B. INTERPRETATION The expansion of genotype 1a before 1965 suggests that nosocomial or iatrogenic factors rather than past sporadic behavioural risk (ie, experimentation with injection drug use, unsafe tattooing, high risk sex, travel to high endemic areas) were key contributors to the hepatitis C virus epidemic in North America. Our results might reduce stigmatisation around screening and diagnosis, potentially increasing rates of screening and treatment for hepatitis C virus. FUNDING The Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, and BC Centre for Excellence in HIV/AIDS.
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Affiliation(s)
- Jeffrey B Joy
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | - Thuy Nguyen
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Yury Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mel Krajden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver, BC, Canada
| | - John W Ward
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - P Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Art F Y Poon
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Li Y, Wang R, Du X, Zhang M, Xie M. Genome-wide analysis for identification of adaptive diversification between hepatitis C virus subtypes 1a and 1b. Can J Microbiol 2016; 62:608-16. [PMID: 27277863 DOI: 10.1139/cjm-2016-0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus (HCV) is a major cause of liver disease and has been estimated to infect approximately 2%-3% of the world's population. HCV genotype 1 is the subject of intense research and clinical investigations because of its worldwide prevalence and poor access to treatment for patients in developing countries and marginalized populations. The predominant subtypes 1a and 1b of HCV genotype 1 present considerable differences in epidemiological features. However, the genetic signature underlying such phenotypic functional divergence is still an open question. Here, we performed a genome-wide evolutionary study on HCV subtypes 1a and 1b. The results show that adaptive selection has driven the diversification between these subtypes. Furthermore, the major adaptive divergence-related changes have occurred on proteins E1, NS4B, NS5A, and NS5B. Structurally, a number of adaptively selected sites cluster in functional regions potentially relevant to (i) membrane attachment and (ii) the interactions with viral and host cell factors and the genome template. These results might provide helpful hints about the molecular determinants of epidemiological divergence between HCV 1a and 1b.
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Affiliation(s)
- Yan Li
- a College of Animal Science and Technology, Sichuan Agricultural University, Wenjiang, People's Republic of China
| | - Ruirui Wang
- b School of Pharmacy, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, People's Republic of China
| | - Xiaogang Du
- c College of Life Science, Sichuan Agricultural University, Yaan, People's Republic of China
| | - Mingwang Zhang
- a College of Animal Science and Technology, Sichuan Agricultural University, Wenjiang, People's Republic of China
| | - Meng Xie
- c College of Life Science, Sichuan Agricultural University, Yaan, People's Republic of China
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30
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Correia-Pinto J, Peleteiro M, Csaba N, González-Fernández Á, Alonso M. Multi-enveloping of particulated antigens with biopolymers and immunostimulant polynucleotides. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2015.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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31
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Leoz M, Feyertag F, Kfutwah A, Mauclère P, Lachenal G, Damond F, De Oliveira F, Lemée V, Simon F, Robertson DL, Plantier JC. The Two-Phase Emergence of Non Pandemic HIV-1 Group O in Cameroon. PLoS Pathog 2015; 11:e1005029. [PMID: 26241860 PMCID: PMC4524642 DOI: 10.1371/journal.ppat.1005029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 06/17/2015] [Indexed: 01/17/2023] Open
Abstract
Unlike the pandemic form of HIV-1 (group M), group O viruses are endemic in west central Africa, especially in Cameroon. However, little is known about group O's genetic evolution, and why this highly divergent lineage has not become pandemic. Using a unique and large set of group O sequences from samples collected from 1987 to 2012, we find that this lineage has evolved in successive slow and fast phases of diversification, with a most recent common ancestor estimated to have existed around 1930 (1914-1944). The most rapid periods of diversification occurred in the 1950s and in the 1980s, and could be linked to favourable epidemiological contexts in Cameroon. Group O genetic diversity reflects this two-phase evolution, with two distinct populations potentially having different viral properties. The currently predominant viral population emerged in the 1980s, from an ancient population which had first developed in the 1950s, and is characterized by higher growth and evolutionary rates, and the natural presence of the Y181C resistance mutation, thought to confer a phenotypic advantage. Our findings show that although this evolutionary pattern is specific to HIV-1 group O, it paralleled the early spread of HIV-1 group M in the Democratic Republic of Congo. Both viral lineages are likely to have benefited from similar epidemiological contexts. The relative role of virological and social factors in the distinct epidemic histories of HIV-1 group O and M needs to be reassessed.
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Affiliation(s)
- Marie Leoz
- Laboratoire de Virologie, CHU Charles Nicolle, Rouen, France
- EA 2656 GRAM, Université de Rouen, Rouen, France
| | - Felix Feyertag
- Computational and Evolutionary Biology, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Anfumbom Kfutwah
- Service de Virologie, Centre Pasteur du Cameroun, Yaoundé, Cameroun
| | - Philippe Mauclère
- Service de Virologie, Centre Pasteur du Cameroun, Yaoundé, Cameroun
- Direction Interarmées du Service de Santé, Nouméa, Nouvelle Calédonie
| | - Guillaume Lachenal
- Laboratoire SPHERE, UMR 7219, Université Paris Diderot & Institut Universitaire de France, Paris, France
| | - Florence Damond
- Service de Virologie, APHP CHU Bichat Claude Bernard, Faculté de Médecine Paris Diderot, Paris, France
| | | | - Véronique Lemée
- EA 2656 GRAM, Université de Rouen, Rouen, France
- Laboratoire associé au Centre National de Référence du VIH, CHU Charles Nicolle, Rouen, France
| | - François Simon
- Service de Microbiologie, APHP CHU Saint Louis, Faculté de Médecine Paris Diderot, Paris, France
| | - David L Robertson
- Computational and Evolutionary Biology, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Jean-Christophe Plantier
- Laboratoire de Virologie, CHU Charles Nicolle, Rouen, France
- EA 2656 GRAM, Université de Rouen, Rouen, France
- Laboratoire associé au Centre National de Référence du VIH, CHU Charles Nicolle, Rouen, France
- * E-mail:
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Gyawali S, Rathore DS, Shankar PR, Kumar VKC, Maskey M, Jha N. Injection practice in Kaski district, Western Nepal: a community perspective. BMC Public Health 2015; 15:435. [PMID: 25928311 PMCID: PMC4425888 DOI: 10.1186/s12889-015-1775-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/22/2015] [Indexed: 12/14/2022] Open
Abstract
Background Previous studies have shown that unsafe injection practice is a major public health problem in Nepal but did not quantify the problem. The present community-based study was planned to: 1) quantify injection usage, 2) identify injection providers, 3) explore differences, if any, in injection usage and injection providers, and 4) study and compare people’s knowledge and perception about injections between the urban and rural areas of Kaski district. Methods A descriptive, cross-sectional mixed-methods study was conducted from July to November 2012, using a questionnaire based survey and focus group discussions (FGDs). A semi-structured questionnaire advocated by the World Health Organization was modified and administered to household heads and injection receivers in selected households and the FGDs were conducted using a topic guide. The district was divided into urban and rural areas and 300 households from each area were selected. Twenty FGDs were held. Results In 218 households (36.33%) [99 in urban and 119 in rural] one or more members received at least one injection. During the three month recall period, 258 subjects (10.44%) reported receiving injection(s) with a median of two injections. The average number of injections per person per year was calculated to be 2.37. Health care workers (34.8%), staff of medical dispensaries (37.7%), physicians (25.2%), and traditional healers (2.3%) were consulted by the respondents for their basic health care needs and for injections. Compared to urban respondents, more rural respondents preferred injections for fever (p < 0.001). People preferred injections due to injections being perceived by them as being powerful, fast-acting, and longer lasting than oral pills. More than 82% of respondents were aware of, and named, at least one disease transmitted by using unsterile syringes during injection administration or when syringes are shared between people. Conclusions Less preference for injections and high awareness about the association between injections and injection-borne infections among the general population is encouraging for safe injection practice. However, respondents were not aware of the importance of having qualified injection providers for safe injections and were receiving injections from unqualified personnel. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1775-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sudesh Gyawali
- Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal.
| | | | - Pathiyil Ravi Shankar
- Department of Pharmacology, Xavier University School of Medicine, Oranjestad, Aruba, Kingdom of the Netherlands.
| | | | - Manisha Maskey
- Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Nepal.
| | - Nisha Jha
- Department of Clinical Pharmacology & Therapeutics, KIST Medical College, Imadol, Nepal.
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Magiorkinis G, Blanco-Melo D, Belshaw R. The decline of human endogenous retroviruses: extinction and survival. Retrovirology 2015; 12:8. [PMID: 25640971 PMCID: PMC4335370 DOI: 10.1186/s12977-015-0136-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/06/2015] [Indexed: 12/21/2022] Open
Abstract
Background Endogenous Retroviruses (ERVs) are retroviruses that over the course of evolution have integrated into germline cells and eventually become part of the host genome. They proliferate within the germline of their host, making up ~5% of the human and mouse genome sequences. Several lines of evidence have suggested a decline in the rate of ERV integration into the human genome in recent evolutionary history but this has not been investigated quantitatively or possible causes explored. Results By dating the integration of ERV loci in 40 mammal species, we show that the human genome and that of other hominoids (great apes and gibbons) have experienced an approximately four-fold decline in the ERV integration rate over the last 10 million years. A major cause is the recent extinction of one very large ERV lineage (HERV-H), which is responsible for most of the integrations over the last 30 million years. The decline however affects most other ERV lineages. Only about 10% of the decline might be attributed to an accompanying increase in body mass (a trait we have shown recently to be negatively correlated with ERV integration rate). Humans are unusual compared to related species – Old World monkeys, great apes and gibbons – in (a) having not acquired any new ERV lineages during the last 30 million years and (b) the possession of an old ERV lineage that has continued to replicate up until at least the last few hundred thousand years – the potentially medically significant HERVK(HML2). Conclusions The human genome shares with the genome of other great apes and gibbons a recent decline in ERV integration that is not typical of other primates and mammals. The human genome differs from that of related species both in maintaining up until at least recently a replicating old ERV lineage and in not having acquired any new lineages. We speculate that the decline in ERV integration in the human genome has been exacerbated by a relatively low burden of horizontally-transmitted retroviruses and subsequent reduced risk of endogenization. Electronic supplementary material The online version of this article (doi:10.1186/s12977-015-0136-x) contains supplementary material, which is available to authorized users.
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Venier AG, Vincent A, L'heriteau F, Floret N, Senechal H, Abiteboul D, Reyreaud E, Coignard B, Parneix P. Surveillance of Occupational Blood and Body Fluid Exposures Among French Healthcare Workers in 2004. Infect Control Hosp Epidemiol 2015; 28:1196-201. [PMID: 17828699 DOI: 10.1086/520742] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 05/14/2007] [Indexed: 11/03/2022]
Abstract
Objective.To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs).Design.Prospective national follow-up of HCWs from January 1 to December 31, 2004.Setting.University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis.Participants.At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire.Results.A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 percutaneous injuries, 22.6% occurred during an injection, 17.9% during blood sampling, and 16.6% during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities, 19.1% during surgery, 14.1% during placement or removal of an intravenous line, and 12.0% during manipulation of a tracheotomy tube. The incidence rates of exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0 exposures), 2.2 per 100 full-time—equivalent physicians (95% CI, 2.4-2.6 exposures), and 7.0 per 100 full-time—equivalent nurses (95% CI, 6.8-7.2 exposures). Human immunodeficiency virus serological status was unknown for 2,789 (21.4%) of 13,041 patients who were the source of the blood and body fluid exposures.Conclusion.National surveillance networks for blood and body fluid exposures help to better document their characteristics and risk factors and can enhance prevention at participating medical centers.
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Affiliation(s)
- A G Venier
- Southwestern France Infection Control Coordinating Center, France
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Asselah T, Perumalswami PV, Dieterich D. Is screening baby boomers for HCV enough? A call to screen for hepatitis C virus in persons from countries of high endemicity. Liver Int 2014; 34:1447-51. [PMID: 24840955 DOI: 10.1111/liv.12599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tarik Asselah
- Centre de Recherche sur l'Inflammation (CRI), INSERM UMR 1149, Université Paris Diderot and Service d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, Paris, France
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Samuel RA, Gopalan PD, Coovadia Y, Samuel R. Infection control in anaesthesia in regional, tertiary and central hospitals in KwaZulu-Natal. Part 1: Unsafe injection practices among anaesthetists. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- RA Samuel
- Department of Anaesthesiology, King Edward VIII Hospital; Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - PD Gopalan
- Department of Anaesthesiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | | | - R Samuel
- Inkosi Albert Luthuli Central Hospital
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The genocidal virus: Addressing beliefs among students of colour that AIDs is a man-made disease (Respond to this article at http://www.therai.org.uk/at/debate). ANTHROPOLOGY TODAY 2014. [DOI: 10.1111/1467-8322.12121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gyawali S, Rathore DS, Shankar PR, Maskey M, Vikash KKC. Injection practices in Nepal: health policymakers' perceptions. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2014; 14:21. [PMID: 24957575 PMCID: PMC4077168 DOI: 10.1186/1472-698x-14-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/20/2014] [Indexed: 12/25/2022]
Abstract
Background The unnecessary and unsafe use of injections is common in developing countries like Nepal. Policymakers have an important role in promoting rational and safe injection use. Hence, the present study was carried out to explore the perception of health policymakers regarding safe injection practice in Nepal. Methods An exploratory qualitative study design was used in this study. Key policymakers from both the central and regional level were selected using purposive sampling. A semi-structured questionnaire advocated by the World Health Organization (WHO) was used after modifying the context. Interviews were conducted to clarify doubts and obtain additional information. The data was analyzed manually using deductive content analysis technique. Results In total, eleven policymakers participated. All unanimously agreed that injection safety is a problem and seven participants reported that injections are overused. They shared the opinion that injections are administered by various providers, including formal and informal health providers, and also quacks. Almost half the respondents reported that the National Drug Policy discourages injection overuse, while others reported that the policy contains no provisions regarding injection overuse. Most policymakers stated that only single-use disposable injection equipment is used to provide injection, while others thought that sterilizable glass syringe is also used. More than half of the participants believed that the quality of injection equipment available in the Nepalese market is not regulated by any government institution. Almost two-third of the policymakers stated that syringes and needles are not reused, while the rest thought syringes might be reused without sterilization in some parts of the country. Almost half of the respondents stated that illegal commercialization of used syringes exists in Nepal. Almost all respondents thought that health care institutions have a waste management plan, while more than half of them opined that such plans are limited to tertiary care hospitals located in the capital. Conclusions The result of this study revealed a divergence of views among policymakers, even among those in the same ministry. Though there has been some effort from the government to increase the safety of injection practices, greater efforts are required, especially with regard to standardization of policies and procedures related to injection practice.
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Affiliation(s)
- Sudesh Gyawali
- Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal.
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Perumalswami PV, DeWolfe Miller F, Orabee H, Regab A, Adams M, Kapelusznik L, Aljibawi F, Pagano W, Tong V, Dieterich DT. Hepatitis C screening beyond CDC guidelines in an Egyptian immigrant community. Liver Int 2014; 34:253-8. [PMID: 23890188 DOI: 10.1111/liv.12259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/17/2013] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Many Egyptian-born persons in the U.S. are at high risk of chronic hepatitis C virus (HCV) infection, yet are not aware of their infection and lack healthcare coverage or linkage to care. In this study, we target Egyptian-born persons living in the New York City area for screening and link to care. METHODS A unique partnership, the Hepatitis Outreach Network (HONE), combines the expertise and resources of the Mount Sinai School of Medicine, the NYC Department of Health and Mental Hygiene and community-based organizations, to provide education, screening and link to care in communities with high prevalence of chronic viral hepatitis. RESULTS Through four community-based screening events, 192 Egyptian-born persons were screened for HCV. Thirty (15.6%) persons were HCV positive. HCV antibody prevalence in those, whose national origin was Egypt, increased strongly with age and was associated with increasing number of years resident in Egypt and rural residents. Of the 30 Egyptian persons with HCV infection, 18 (60%) received a medical evaluation (2 with local providers and 16 at Mount Sinai). Of the HCV-infected persons evaluated, treatment was recommended in four and begun in three (75%). CONCLUSION Egyptian-born persons living in the New York City area have a high burden of HCV disease. HONE has successfully established targeted HCV screening in Egyptian-born persons through use of several unique elements that effectively link them to care.
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Affiliation(s)
- Ponni V Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Microneedles were initially developed as pretreatment tools for the delivery of therapeutic drugs to intradermal locales in the human skin. Over time, variations in microneedle forms and functions burgeoned through the works of many researchers worldwide. The four major types of microneedles in use today are solid, dissolving, coating, and hollow microneedles. The emergence of different types of microneedles also paved the way for a flourishing diversification of microneedle applications, one of the most remarkable of which deals with the transcutaneous delivery of prophylactic vaccines. Here, we describe fabrication methods of microneedles and DNA vaccine loading methods on the microneedle surface. Furthermore, in the latter part of this chapter, in vivo test protocols for assessing the efficacy of gene delivery using microneedles are described.
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Andernach IE, Hunewald OE, Muller CP. Bayesian inference of the evolution of HBV/E. PLoS One 2013; 8:e81690. [PMID: 24312336 PMCID: PMC3843692 DOI: 10.1371/journal.pone.0081690] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 10/21/2013] [Indexed: 12/16/2022] Open
Abstract
Despite its wide spread and high prevalence in sub-Saharan Africa, hepatitis B virus genotype E (HBV/E) has a surprisingly low genetic diversity, indicating an only recent emergence of this genotype in the general African population. Here, we performed extensive phylogeographic analyses, including Bayesian MCMC modeling. Our results indicate a mutation rate of 1.9×10−4 substitutions per site and year (s/s/y) and confirm a recent emergence of HBV/E, most likely within the last 130 years, and only after the transatlantic slave-trade had come to an end. Our analyses suggest that HBV/E originated from the area of Nigeria, before rapidly spreading throughout sub-Saharan Africa. Interestingly, viral strains found in Haiti seem to be the result of multiple introductions only in the second half of the 20th century, corroborating an absence of a significant number of HBV/E strains in West Africa several centuries ago. Our results confirm that the hyperendemicity of HBV(E) in today's Africa is a recent phenomenon and likely the result of dramatic changes in the routes of viral transmission in a relatively recent past.
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Affiliation(s)
- Iris E. Andernach
- Institute of Immunology, Centre de Recherche Public de la Santé/Laboratoire National de Santé, Luxembourg, Luxembourg
| | - Oliver E. Hunewald
- Institute of Immunology, Centre de Recherche Public de la Santé/Laboratoire National de Santé, Luxembourg, Luxembourg
| | - Claude P. Muller
- Institute of Immunology, Centre de Recherche Public de la Santé/Laboratoire National de Santé, Luxembourg, Luxembourg
- * E-mail:
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Abstract
The origin of hepatitis C virus (HCV) can be conceptualised at several levels. Firstly, origins might refer to its dramatic spread throughout the Western world and developing countries throughout the twentieth century. As a blood-borne virus, this epidemic was fuelled by new parenteral transmission routes associated with medical treatments, immunisation, blood transfusion and more recently injecting drug use. At another level, however, origins might refer to the immediate sources of HCV associated with its pandemic spread, now identified as areas in Central and West sub-Saharan Africa and South and South East Asia where genetically diverse variants of HCV appear to have circulated for hundreds of years. Going back a final step to the actual source of HCV infection in these endemic areas, non-human primates have been long suspected as harbouring viruses related to HCV with potential cross-species transmission of variants corresponding to the 7 main genotypes into humans. Although there is tempting analogy between this and the clearly zoonotic origin of HIV-1 from chimpanzees in Central Africa, no published evidence to date has been obtained for infection of HCV-like viruses in either apes or Old World monkey species. Indeed, a radical re-think of both the host range and host-specificity of hepaciviruses is now required following the very recent findings of a non-primate hepacivirus (NPHV) in horses and potentially in dogs. Further research on a much wider range of mammals is needed to better understand the true genetic diversity of HCV-like viruses and their host ranges in the search for the ultimate origin of HCV in humans.
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Gupta E, Bajpai M, Sharma P, Shah A, Sarin S. Unsafe injection practices: a potential weapon for the outbreak of blood borne viruses in the community. Ann Med Health Sci Res 2013; 3:177-81. [PMID: 23919185 PMCID: PMC3728858 DOI: 10.4103/2141-9248.113657] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Unsafe injection practices are common in developing nations. Such practices, through contaminated needles and syringes, place injection recipient, healthcare workers and the community at large at risk of infection with blood borne viruses. Aim: An attempt was made to briefly describe an acute hepatitis outbreak that occurred in Gujarat, India, due to unsafe injection practices with a brief review of the literature. Subjects and Methods: An outbreak of acute hepatitis occurred in February-March 2009 in the Sabarkantha district of Gujarat in India. Blood samples were collected randomly from 25 cases, admitted in the local hospital during the ongoing outbreak. Screening was done using an immunoassay analyzer (Cobas e411; Roche Diagnostics, Indianapolis, IN, USA) for hepatitis B surface antigen (HBsAg), IgM and total antibodies to hepatitis B core antigen (HBc), hepatitis B e antigen (HBeAg) and antibody to HBe, antibodies to HCV, HIV and IgM antibodies to hepatitis A virus (HAV), as per the manufacturer's protocol. Results: Gross and continuous use of contaminated needle and syringes were responsible for this outbreak as all the patients gave history of receiving injections about 2-3 months prior to the development of clinical signs and symptoms, from one particular doctor. Mean age of the patients was 33.4 years (SD 12.9 years). Seventeen of these patients were males and eight were females. All patients were hepatitis B surface antigen positive, with median levels as 35,450 IU/mL (IQR 450-2,49,750 IU/mL). IgM HBc was positive in 22/25 (88%). HBe Ag was positive in 11 patients (44%). The median HBV DNA level was 2.6 × 104 IU/mL (IQR 1.18 × 102 to 6.7 × 106 IU/mL). No significant co-infection with other hepatitis viruses existed. All isolates were genotype D. Conclusions: The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis B infection, need to start routine surveillance system and increase awareness in health care workers regarding safe injection practices.
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Affiliation(s)
- E Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, Sector D1, Vasant Kunj, New Delhi, India
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Forbi JC, Ben-Ayed Y, Xia GL, Vaughan G, Drobeniuc J, Switzer WM, Khudyakov YE. Disparate distribution of hepatitis B virus genotypes in four sub-Saharan African countries. J Clin Virol 2013; 58:59-66. [PMID: 23871163 DOI: 10.1016/j.jcv.2013.06.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/23/2013] [Accepted: 06/21/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) places a substantial health burden on Africa. Here, we investigated genetic diversity of HBV variants circulating in 4 countries of sub-Saharan Africa using archived samples. In total, 1492 plasma samples were tested from HIV-infected individuals and pregnant women, among which 143 (9.6%) were PCR-positive for HBV DNA (Côte d'Ivoire, 70/608 [11.5%]; Ghana, 13/444 [2.9%]; Cameroon, 33/303 [10.9%]; and Uganda, 27/137 [19.7%]). STUDY DESIGN/RESULTS Phylogenetic analysis of the S-gene sequences identified HBV genotypes E (HBV/E, n=96) and A (HBV/A, n=47) distributed as follows: 87% of HBV/E and 13% of HBV/A in Côte d'Ivoire; 100% of HBV/E in Ghana; 67% of HBV/E and 33% of HBV/A in Cameroon; and 100% of HBV/A in Uganda. The average and maximal nucleotide distances among HBV/E sequences were 1.9% and 6.4%, respectively, suggesting a greater genetic diversity for this genotype than previously reported (p<0.001). HBV/A strains were classified into subgenotypes HBV/A1, HBV/A2 and HBV/A3. In Uganda, 93% of HBV/A strains belonged to HBV/A1 whereas HBV/A3 was the only subgenotype of HBV/A found in Cameroon. In Côte d'Ivoire, HBV/A strains were classified as HBV/A1 (11.1%), HBV/A2 (33.3%) and HBV/A3 (55.6%). Phylogeographic analysis of the sequences available from Africa supported earlier suggestions on the origin of HBV/A1, HBV/A2 and HBV/A3 in East, South and West/Central Africa, respectively. Using predicted amino acid sequences, hepatitis B surface antigen (HBsAg) was classified into serotype ayw4 in 93% of HBV/E strains and adw2 in 68% of HBV/A strains. Also, 7.7% of the sequences carried substitutions in HBsAg associated with immune escape. CONCLUSIONS The observations of pan-African and global dissemination of HBV/A1 and HBV/A2, and the circulation of HBV/E and HBV/A3 almost exclusively in West and Central Africa suggest a more recent increase in prevalence in Africa of HBV/E and HBV/A3 compared to HBV/A1 and HBV/A2. The broad genetic heterogeneity of HBsAg detected here may impact the efficacy of prevention and control efforts in sub-Saharan Africa.
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Affiliation(s)
- Joseph C Forbi
- Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
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Evidence for two phylogenetic clusters within hepatitis C virus (HCV) genotype 2 inferred from analysis of complete coding sequences of 15 HCV strains. J Med Virol 2013; 85:1754-64. [DOI: 10.1002/jmv.23674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 02/05/2023]
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Gyawali S, Rathore DS, Shankar PR, Kumar KV. Strategies and challenges for safe injection practice in developing countries. J Pharmacol Pharmacother 2013; 4:8-12. [PMID: 23662018 PMCID: PMC3643353 DOI: 10.4103/0976-500x.107634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.
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Affiliation(s)
- Sudesh Gyawali
- Department of Pharmacology, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal ; PhD Scholar, Suresh GyanVihar University, Jaipur, India
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Abkar MAA, Wahdan IMH, Sherif AAR, Raja'a YA. Unsafe injection practices in Hodeidah governorate, Yemen. J Infect Public Health 2013; 6:252-60. [PMID: 23806699 DOI: 10.1016/j.jiph.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/31/2012] [Accepted: 01/06/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Unsafe injection practices are a major public health problem and can lead to the transmission of bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). METHODS The present study was conducted to determine the nature and magnitude of unsafe injection practices in healthcare facilities in Hodeidah governorate, Yemen. The study was conducted in two hospitals and a representative sample of the governorate's health centers. A total of 1600 injections were observed in these facilities. RESULTS This study revealed several unsafe practices, particularly the recapping of needles after use, which occurred in 61.1% and 36.8% of the observations in the hospitals and the health centers, respectively. CONCLUSION This study showed that most healthcare workers (HCWs) followed the proper injection protocols but performed some procedures that exposed themselves and the community to the risk of needlestick injuries (NSIs) and bloodborne infections.
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Affiliation(s)
- Mohammed Abdo Abdo Abkar
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
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Plank RM, Kubiak DW, Abdullahi RB, Ndubuka N, Nkgau MM, Dapaah-Siakwan F, Powis KM, Lockman S. Loss of anatomical landmarks with eutectic mixture of local anesthetic cream for neonatal male circumcision. J Pediatr Urol 2013; 9:e86-90. [PMID: 23102766 PMCID: PMC3568457 DOI: 10.1016/j.jpurol.2012.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare.
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Affiliation(s)
- Rebeca M Plank
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA.
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Choi CK, Lee KJ, Youn YN, Jang EH, Kim W, Min BK, Ryu W. Spatially discrete thermal drawing of biodegradable microneedles for vascular drug delivery. Eur J Pharm Biopharm 2013. [DOI: 10.1016/j.ejpb.2012.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gyawali S, Rathore DS, Kc B, Shankar PR. Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:3. [PMID: 23286907 PMCID: PMC3583689 DOI: 10.1186/1472-698x-13-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 12/27/2012] [Indexed: 12/29/2022]
Abstract
UNLABELLED BACKGROUND Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. METHODOLOGY A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. RESULTS The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. CONCLUSIONS Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.
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Affiliation(s)
- Sudesh Gyawali
- School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India; Department of Pharmacology, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal.
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