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Soderquist M, Delgado G, Abdelfattah H, Thoder J, Solarz M. Necrotic Upper-Extremity Infections in People Who Inject Drugs: A Case Series. J Hand Surg Am 2024; 49:459-464. [PMID: 37178065 DOI: 10.1016/j.jhsa.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Our institution has noted an increase in severe upper-extremity infections within the last 2 years. These patients have required transhumeral amputation. This case series demonstrates some of the catastrophic outcomes of these infections in people who inject drugs, which has been postulated to be related to the addition of xylazine to injectable drugs in our community. METHODS The study included patients presenting with severe upper-extremity infections resulting from intravenous drug use and requiring upper-extremity amputation between January 1, 2020 and September 30, 2022 at a single, urban, level 1 trauma center. Patient information and clinical images were collected through retrospective chart review. RESULTS Eight patients were identified at our institution with extensive necrosis of the skin and soft tissues in the forearm and hand, resulting in exposure of the radius and ulna. None of these patients had viable motor function in the hand and presented with a lack of sensation. All underwent transhumeral amputations, including bilaterally in one case. CONCLUSIONS The patients in this case series self-reported injection of tranquilizer-containing drugs, and xylazine has been reported to be present in 91% of heroin and fentanyl samples in our community. Although more studies are needed to confirm that xylazine is the definitive cause of the extensive tissue necrosis seen in these patients, we have found the severity of these infections to be noteworthy, given the likely expansion of xylazine to drug samples beyond our region. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Melissa Soderquist
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA.
| | - Gabriel Delgado
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Hesham Abdelfattah
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA
| | - Joseph Thoder
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA
| | - Mark Solarz
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA
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Ghojoghi A, Khodavaisy S, Mahmoudabadi AZ, Nazar E, Fatahinia M. Exploring the diversity of uncommon oral yeast species and associated risk factors among substance abusers in southwestern Iran. Sci Rep 2024; 14:1906. [PMID: 38253731 PMCID: PMC10803760 DOI: 10.1038/s41598-024-52105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Yeast species are a group of coexistent microorganisms in the oral cavity that can cause opportunistic infections in vulnerable individuals, including addicts. This study aimed to identify the yeast species profile responsible for oral yeast colonization (OYC) and the associated risk factors in patients with substance use disorder (SUD) in Ahvaz, Iran. Oral samples were collected from drug users hospitalized in 12 addiction treatment centers, and the related clinical information was mined. Oral yeast species were identified using 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). A total of 244 yeast strains were identified from 245 individuals with substance abuse. Candida albicans was the most common species (37.7%) and non-albicans Candida was responsible for 57.7% of OYC, primarily C. dubliniensis (33.2%) and C. glabrata (11.9%). Moreover, uncommon oral yeasts constituted 5.3% of species, including Saccharomyces cerevisiae, Clavispora lusitaniae, Pichia kluyveri, Geotrichum candidum, Magnusiomyces capitatus, Hanseniospora opuntiae, Wickerhamomyces subpelliculosus, Trichosporon asahii, and Aureobasidium pullulans. Importantly, OYC exhibited associations with such factors as duration of drug use, daily drug consumption rate, opioid utilization, oral drug administration, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) score. The present study is the pioneering investigation revealing the prevalence and diversity of oral yeast species, along with associated risk factors, in individuals with SUD in southwestern Iran. Furthermore, it underscores the importance of developing efficient and cost-effective diagnostic methods tailored for resource-constrained settings.
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Affiliation(s)
- Aynaz Ghojoghi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Cellular and Molecular Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Zarei Mahmoudabadi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Eisa Nazar
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahnaz Fatahinia
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Cellular and Molecular Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Mehrpour O, Alemzadeh E, Ghasemi S, Farkhondeh T, Ziaee M. Differences in Clinical and Lab Characteristics of Sepsis between Opium User Patients and Patients with No Illicit Drug Addiction. Cardiovasc Hematol Agents Med Chem 2024; 22:151-158. [PMID: 37202897 DOI: 10.2174/1871525721666230518101627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Sepsis is a significant cause of mortality worldwide. This study aimed to compare clinical and laboratory characteristics of sepsis in patients addicted to illicit drugs versus patients with no illicit drug addiction. METHODS In this cross-sectional study, all patients hospitalized with sepsis diagnosis were recruited within six months from September to March 2019. Sixty patients for each group (illicit drugaddicted and non-addicted individuals) were selected. The data relating to illicit drug consumption, serum indices, the current focus of infection, duration of hospitalization, and disease outcomes were collected. Patients who had an illicit drug addiction were compared with non-addicted patients in terms of clinical and laboratory parameters. The data collected were analyzed using SPSS software (version 19). RESULTS The bacterial load in the urine culture was statistically significant in both groups and higher in the non-addicted group. The frequency distributions of focus of infection, duration of hospitalization, and outcome were not significantly different between the two groups. The serum sodium and total neutrophils were significantly higher in the addicted group. However, the MCHC level was significantly lower (p < 0.05). CONCLUSION Opium may have stimulated the immune system and reduced bacterial infection in septic patient users.
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Affiliation(s)
- Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Effat Alemzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeedeh Ghasemi
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Tahereh Farkhondeh
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Masood Ziaee
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Balali-Mood M, Sinclair RD, Darchini-Maragheh E, Etemad L. Mucocutaneous alterations and complications in amphetamine abusers: a narrative review. Cutan Ocul Toxicol 2023; 42:219-231. [PMID: 37450708 DOI: 10.1080/15569527.2023.2235425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Amphetamines are the second most commonly used illicit drug worldwide. Amphetamine use can result in significant cutaneous morbidity. This review highlights the dermatological manifestations of amphetamine abuse.
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Affiliation(s)
- Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Rodney D Sinclair
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Sinclair Dermatology, Melbourne, Australia
| | - Emadodin Darchini-Maragheh
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Sinclair Dermatology, Melbourne, Australia
| | - Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Drug Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Martín-Escolano R, Vidal-Alcántara EJ, Crespo J, Ryan P, Real LM, Lazo-Álvarez JI, Cabezas-González J, Macías J, Arias-Loste MT, Cuevas G, Virseda-Berdices A, Briz V, Resino S, Jiménez-Sousa MÁ, Fernández-Rodríguez A. Immunological and senescence biomarker profiles in patients after spontaneous clearance of hepatitis C virus: gender implications for long-term health risk. Immun Ageing 2023; 20:62. [PMID: 37978401 PMCID: PMC10655350 DOI: 10.1186/s12979-023-00387-z] [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: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND About 25% of patients with acute hepatitis C virus (HCV) infection show spontaneous clearance within the first six months of infection but may remain at risk of inflammaging, aging, and liver and non-liver disease complications. This study evaluated the differences in the plasma levels of immune checkpoints (ICs) and senescence-associated secretory phenotype (SASP) biomarkers between patients who had spontaneously eliminated HCV infection (SC group) and individuals without evidence of HCV infection (C group). METHODS We performed a multicenter retrospective study of 56 individuals: 32 in the SC and 24 in the C groups. ICs and SASP proteins were analyzed using a Luminex 200TM analyzer. The statistical analysis used Generalized Linear Models with gamma distribution (log-link) adjusted by significant variables and sex. RESULTS 13 ICs (BTLA, CD137(4-1BB), CD27, CD28, CD80, GITR, HVEM, IDO, LAG-3, PD-1, PD-L1, PD-L2, and TIM-3) and 13 SASP proteins (EGF, Eotaxin, IL-1alpha, IL-1RA, IL-8, IL-13, IL-18, IP-10, SDF-1alpha, HGF, beta-NGF, PLGF-1, and SCF) were significantly higher in SC group after approximately more than two years of HCV clearance. After stratifying by sex, differences remained significant for males, which showed higher levels for 13 ICs and 4 SASP proteins in SC. While only PD-L2 was significantly higher in SC women, and no differences in SASP were found. CONCLUSIONS Higher plasma levels of different IC and SASP proteins were found in individuals after more than two years of HCV clearance, mainly in men. Alterations in these molecules might be associated with an increased risk of developing liver and non-hepatic diseases.
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Affiliation(s)
- Rubén Martín-Escolano
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda- Pozuelo, Km 2.2, Madrid, Majadahonda, 28220, Spain
| | - Erick Joan Vidal-Alcántara
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda- Pozuelo, Km 2.2, Madrid, Majadahonda, 28220, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Traslational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pablo Ryan
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Facultad de Medicina, Universidad Complutense de Madrid, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Luis Miguel Real
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen de Valme Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - Juan Ignacio Lazo-Álvarez
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Facultad de Medicina, Universidad Complutense de Madrid, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Joaquín Cabezas-González
- Gastroenterology and Hepatology Department, Clinical and Traslational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Juan Macías
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen de Valme Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - María Teresa Arias-Loste
- Gastroenterology and Hepatology Department, Clinical and Traslational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Facultad de Medicina, Universidad Complutense de Madrid, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ana Virseda-Berdices
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda- Pozuelo, Km 2.2, Madrid, Majadahonda, 28220, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Veronica Briz
- Laboratory of Reference and Research On Viral Hepatitis, National Center for Microbiology, Institute of Health Carlos III, Madrid, Majadahonda, Spain
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda- Pozuelo, Km 2.2, Madrid, Majadahonda, 28220, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María Ángeles Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda- Pozuelo, Km 2.2, Madrid, Majadahonda, 28220, Spain.
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Amanda Fernández-Rodríguez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda- Pozuelo, Km 2.2, Madrid, Majadahonda, 28220, Spain.
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Risk of somatic diseases in patients with eating disorders: the role of comorbid substance use disorders. Epidemiol Psychiatr Sci 2022; 31:e73. [PMID: 36245431 PMCID: PMC9583632 DOI: 10.1017/s204579602200052x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Eating disorders (EDs) and substance use disorders (SUDs) often co-occur, and both involve somatic diseases. So far, no study has considered whether comorbid SUDs may impact somatic disease risk in patients with EDs. Therefore, this study aimed to examine the impact of comorbid SUDs on the risk of 11 somatic disease categories in patients with anorexia nervosa (AN), bulimia nervosa (BN) and unspecified eating disorder (USED) compared to matched controls. METHODS A retrospective cohort study was conducted using Danish nationwide registries. The study population included 20 759 patients with EDs and 83 036 controls matched on month and year of birth, sex and ethnicity. Hazard ratios (HRs) were calculated to compare the risk of being diagnosed with a somatic disease (within 11 categories defined by the ICD-10) following first ED diagnosis (index date) between ED patients and controls both with and without SUDs (alcohol, cannabis or hard drugs). RESULTS The ED cohort and matched controls were followed for 227 538 and 939 628 person-years, respectively. For ED patients with SUDs, the risk pattern for being diagnosed with different somatic diseases (relative to controls without SUDs) varied according to type of ED and SUD [adjusted HRs ranged from 0.95 (99% CI = 0.57; 1.59) to 4.17 (2.68, 6.47)]. The risk estimates observed among ED patients with SUDs were generally higher than those observed among ED patients without SUDs [adjusted HRs ranged from 1.08 (99% CI = 0.95, 1.22) to 2.56 (2.31, 2.84)]. Abuse of alcohol only had a non-synergistic effect on six disease categories in AN patients and five in BN and USED patients. Abuse of cannabis (with/without alcohol) had a non-synergistic effect on five disease categories in AN and BN patients and two in USED patients. Abuse of hard drugs (with/without alcohol or cannabis) had a non-synergistic effect on nine disease categories in AN patients, eight in BN patients and seven in USED patients. CONCLUSIONS The present study documents non-synergistic but not synergistic harmful somatic consequences of SUDs among patients with different EDs, with AN and hard drugs being the most predominant factors. Hence, EDs and SUDs did not interact and result in greater somatic disease risk than that caused by the independent effects. Since EDs and SUDs have independent effects on many somatic diseases, it is important to monitor and treat ED patients for SUD comorbidity to prevent exacerbated physical damage in this vulnerable population.
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Javan GT, Wells T, Allen J, Visona S, Moretti M, Tipton C, Scott L, Finley SJ. Correlation between postmortem microbial signatures and substance abuse disorders. PLoS One 2022; 17:e0274401. [PMID: 36155553 PMCID: PMC9512198 DOI: 10.1371/journal.pone.0274401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
The microbiota gut-brain-axis is a bidirectional circuit that links the neural, endocrine, and immunological systems with gut microbial communities. The gut microbiome plays significant roles in human mind and behavior, specifically pain perception, learning capacity, memory, and temperament. Studies have shown that disruptions in the gut microbiota have been associated with substance use disorders. The interplay of gut microbiota in substance abuse disorders has not been elucidated; however, postmortem microbiome profiles may produce promising avenues for future forensic investigations. The goal of the current study was to determine gut microbiome composition in substance abuse disorder cases using transverse colon tissues of 21 drug overdose versus 19 non-overdose-related cases. We hypothesized that postmortem samples of the same cause of death will reveal similar microbial taxonomic relationships. We compared microbial diversity profiles using amplicon-based sequencing of the 16S rRNA gene V4 hypervariable region. The results demonstrated that the microbial abundance in younger-aged cases were found to have significantly more operational taxonomic units than older cases. Using weighted UniFrac analysis, the influence of substances in overdose cases was found to be a significant factor in determining microbiome similarity. The results also revealed that samples of the same cause of death cluster together, showing a high degree of similarity between samples and a low degree of similarity among samples of different causes of death. In conclusion, our examination of human transverse colon microflora in decomposing remains extends emerging literature on postmortem microbial communities, which will ultimately contribute to advanced knowledge of human putrefaction.
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Affiliation(s)
- Gulnaz T. Javan
- Department of Physical Sciences and Forensic Science Programs, Alabama State University, Montgomery, Alabama, United States of America
- * E-mail:
| | - Tiara Wells
- Department of Physical Sciences and Forensic Science Programs, Alabama State University, Montgomery, Alabama, United States of America
| | - Jamese Allen
- Department of Physical Sciences and Forensic Science Programs, Alabama State University, Montgomery, Alabama, United States of America
| | - Silvia Visona
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Matteo Moretti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Craig Tipton
- RTL Genomics, Lubbock, Texas, United States of America
- Department of Biological Sciences, Texas Tech University, Lubbock, Texas, United States of America
| | - Latia Scott
- Department of Biological Sciences, Delaware State University, Dover, Delaware, United States of America
- College of Agriculture, Virginia State University, Petersburg, Virginia, United States of America
| | - Sheree J. Finley
- Department of Physical Sciences and Forensic Science Programs, Alabama State University, Montgomery, Alabama, United States of America
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Moran GJ, Chitra S, McGovern PC. Efficacy and Safety of Omadacycline Versus Linezolid in Acute Bacterial Skin and Skin Structure Infections in Persons Who Inject Drugs. Infect Dis Ther 2022; 11:517-531. [PMID: 35015255 PMCID: PMC8847501 DOI: 10.1007/s40121-021-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/23/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Acute bacterial skin and skin structure infections (ABSSSI) represent one of the most common reasons for emergency department visits, and are frequent complications of intravenous drug use in persons who inject drugs (PWID). This study examined the efficacy and safety of omadacycline, versus linezolid, in PWID and persons who do not inject drugs, in the Phase 3 Omadacycline in Acute Skin and Skin Structure Infection (OASIS-1, OASIS-2) studies. Methods Eligible participants were aged ≥ 18 years with qualifying skin infections: wound infection, cellulitis, erysipelas, or major abscess. The primary efficacy endpoint was early clinical response (ECR) in the modified intent-to-treat (mITT) population, defined as survival with ≥ 20% reduction in lesion size at 48–72 h after the first dose of omadacycline or linezolid. Key secondary endpoints included investigator-assessed clinical response at the post-treatment evaluation (PTE) in the mITT and clinical per-protocol populations, and clinical response at PTE in the micro-mITT population. Safety was assessed based on adverse events (AEs) and standard clinical laboratory tests. Efficacy endpoints of clinical response at ECR and PTE were analyzed for the mITT and clinically evaluable (CE) PTE populations. Results In total, 1380 patients (822 PWID, 558 non-PWID) were included in this secondary analysis. Wound infections were reported more frequently in the PWID subgroup (72.8%) at baseline; cellulitis or erysipelas (43.9%) and major abscess (37.4%) were the most frequently reported baseline infections in the non-PWID subgroup. Clinical success rates at ECR and PTE in the mITT population, and at PTE in the CE population, were high for patients receiving omadacycline or linezolid. Severe or serious treatment-emergent AEs (TEAEs), and TEAEs leading to discontinuation, were infrequent. Conclusion This subgroup analysis showed that omadacycline was effective and well tolerated, regardless of PWID status.
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Affiliation(s)
- Gregory J Moran
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA, 91342, USA.
| | - Surya Chitra
- Paratek Pharmaceuticals, Inc., King of Prussia, PA, USA
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Kaur S, Sharma N, Roy A. Role of cannabinoids in various diseases: A review. Curr Pharm Biotechnol 2021; 23:1346-1358. [PMID: 34951355 DOI: 10.2174/1389201023666211223164656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/21/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The plant, Cannabis sativa is heavily explored and researched with many industrial and pharmaceutical applications. The medicinal and therapeutic role of cannabis Sativa has been summarized in the paper, citing its mechanism of action and influence on the human body. Diseases like metabolic disorders, infectious diseases, and psychological disorders pose negative and long-term drastic effects on the body like neurodegeneration and other chronic system failures. Several existing literature has proved its effectiveness against such diseases. OBJECTIVES This review aims to provide an overview of the role of cannabinoids in various diseases like metabolic disorders, infectious diseases, and psychological disorders. METHOD Various e-resources like Pubmed, Science Direct, and Google Scholar were thoroughly searched and read to form a well-informed and information-heavy manuscript. Here we tried to summaries the therapeutic aspect of Cannabis sativa and its bioactive compound cannabinoids in various diseases. RESULT This review highlights the various constituents which are present in Cannabis sativa, the Endocannabinoid system, and the role of cannabinoids in various diseases Conclusion: Recent research on Cannabis has suggested its role in neurodegenerative diseases, inflammation, sleep disorders, pediatric diseases, and their analgesic nature. Therefore, the authors majorly focus on the therapeutic aspect of Cannabis sativa in various diseases. The focus is also on the endocannabinoid system (ECS) and its role in fighting or preventing bacterial, parasitic, fungal, and viral infections.
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Affiliation(s)
- Simran Kaur
- Department of Biotechnology, Delhi Technological University. India
| | - Nikita Sharma
- Department of Biotechnology, Delhi Technological University, Delhi. India
| | - Arpita Roy
- Department of Biotechnology, School of Engineering & Technology, Sharda University, Greater Noida. India
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Che B, Zhang W, Xu S, Yin J, He J, Huang T, Li W, Yu Y, Tang K. Prostate Microbiota and Prostate Cancer: A New Trend in Treatment. Front Oncol 2021; 11:805459. [PMID: 34956913 PMCID: PMC8702560 DOI: 10.3389/fonc.2021.805459] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/22/2021] [Indexed: 01/01/2023] Open
Abstract
Although the incidence and mortality of prostate cancer have gradually begun to decline in the past few years, it is still one of the leading causes of death from malignant tumors in the world. The occurrence and development of prostate cancer are affected by race, family history, microenvironment, and other factors. In recent decades, more and more studies have confirmed that prostate microflora in the tumor microenvironment may play an important role in the occurrence, development, and prognosis of prostate cancer. Microorganisms or their metabolites may affect the occurrence and metastasis of cancer cells or regulate anti-cancer immune surveillance. In addition, the use of tumor microenvironment bacteria in interventional targeting therapy of tumors also shows a unique advantage. In this review, we introduce the pathway of microbiota into prostate cancer, focusing on the mechanism of microorganisms in tumorigenesis and development, as well as the prospect and significance of microorganisms as tumor biomarkers and tumor prevention and treatment.
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Affiliation(s)
- Bangwei Che
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wenjun Zhang
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shenghan Xu
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingju Yin
- Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun He
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tao Huang
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Wei Li
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ying Yu
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Kaifa Tang
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Institute of Medical Science of Guizhou Medical University, Guiyang, China
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11
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Watkins RR, David MZ. Approach to the Patient with a Skin and Soft Tissue Infection. Infect Dis Clin North Am 2021; 35:1-48. [PMID: 33494872 DOI: 10.1016/j.idc.2020.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The diagnosis of a skin and soft tissue infection (SSTI) requires careful attention to a patient's history, physical examination, and diagnostic test results. We review for many bacterial, viral, fungal, and parasitic pathogens that cause SSTIs the clues for reaching a diagnosis, including reported past medical history, hobbies and behaviors, travel, insect bites, exposure to other people and to animals, environmental exposures to water, soil, or sand, as well as the anatomic site of skin lesions, their morphology on examination, and their evolution over time. Laboratory and radiographic tests are discussed that may be used to confirm a specific diagnosis.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, 224 West Exchange Street, Akron, OH 44302, USA; Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Blockley Hall 707, Philadelphia, PA 19104, USA; Department of Epidemiology, Biostatistics and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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12
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Lloyd M, Ransom EM, Anderson NW, Farnsworth CW. Evaluation of Infectious Disease Test Ordering and Positivity Rates in Illicit Fentanyl Users. J Appl Lab Med 2020; 6:79-92. [PMID: 33313803 DOI: 10.1093/jalm/jfaa194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/12/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The emergence of illicit fentanyl use has resulted in considerable morbidity and mortality. Although illicit use of other opioids has been associated with transmission of viral and bacterial infections, limited data exist for the prevalence of infectious diseases among illicit fentanyl users. The purpose of this study was to assess the likelihood of infectious disease testing and infection prevalence among illicit fentanyl users. METHODS Results from urine drug screens (UDSs) performed from August 13, 2019, to October 16, 2019, were obtained from the laboratory information system with concurrent microbial testing. Patients were categorized based on UDS results, and illicit drug use was inferred from physician encounter notes in the electronic medical record. RESULTS Suspected illicit drugs users with fentanyl detected by UDS were more likely to be screened [odds ratio (OR): 1.7; 95% CI, 1.26-2.4] and test positive for hepatitis C virus (HCV) by immunoassay (OR: 5.89; 95% CI, 2.93-11.31) than patients without drugs detected. Patients with suspected illicit fentanyl use who were discharged from the emergency department (ED) were less likely to be tested for HCV than patients in outpatient settings (OR: 3.47; 95% CI, 1.05-10.4) and inpatient settings (OR: 17.43; 95% CI, 6.53-45.88). Patients with suspected illicit fentanyl use were more likely to have infected abscesses or wounds (OR: 5.12; 95% CI, 2.07-13.7) and Staphylococcus aureus infections (OR: 4.5; 95% CI, 1.59-12.28) than patients without drugs detected. CONCLUSIONS Patients with a positive UDS for fentanyl and suspected illicit use were more likely to test positive for HCV, were rarely screened for HCV in the ED, and had an increased risk of invasive S. aureus wound or abscess infection. These findings may represent considerable barriers to care for patients who use fentanyl illicitly.
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Affiliation(s)
- Matthew Lloyd
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Eric M Ransom
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Neil W Anderson
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
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Farnsworth CW, Lloyd M, Jean S. Opioid Use Disorder and Associated Infectious Disease: The Role of the Laboratory in Addressing Health Disparities. J Appl Lab Med 2020; 6:180-193. [PMID: 33438735 DOI: 10.1093/jalm/jfaa150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Opioid use disorder, defined as a pattern of problematic opioid use leading to clinically significant impairment, has resulted in considerable morbidity and mortality throughout the world. This is due, at least in part, to the marginalized status of patients with opioid use disorder, limiting their access to appropriate laboratory testing, diagnosis, and treatment. Infections have long been associated with illicit drug use and contribute considerably to morbidity and mortality. However, barriers to testing and negative stigmas associated with opioid use disorder present unique challenges to infectious disease testing in this patient population. CONTENT This review addresses the associations between opioid use disorder and infectious organisms, highlighting the health disparities encountered by patients with opioid use disorder, and the important role of laboratory testing for diagnosing and managing these patients. SUMMARY Infections are among the most frequent and adverse complications among patients with opioid use disorder. As a result of health disparities and systemic biases, patients that misuse opioids are less likely to receive laboratory testing and treatment. However, laboratories play a crucial in identifying patients that use drugs illicitly and infections associated with illicit drug use.
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Affiliation(s)
- Christopher W Farnsworth
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Matthew Lloyd
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Sophonie Jean
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
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14
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Vida RG, Merczel S, Jáhn E, Fittler A. Developing a framework regarding a complex risk based methodology in the evaluation of hazards associated with medicinal products sourced via the internet. Saudi Pharm J 2020; 28:1733-1742. [PMID: 33424264 PMCID: PMC7783221 DOI: 10.1016/j.jsps.2020.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/31/2020] [Indexed: 11/18/2022] Open
Abstract
Today, the increasing number of illicit internet pharmacies is a global phenomenon, however, the size of the online pharmaceutical market is still relatively unknown and the dubious quality of products is questionable and warrants investigation. Descriptive data from this black market channel are derived from studies analyzing the online availability of different medications procured over the internet and their methodology is quite heterogeneous. Our aim was to develop a comprehensive and specific risk assessment for selecting high patient safety risk medications from the online pharmaceutical market. A rapid tool was developed based upon the two quality and safety standard resolutions in pharmaceutical practice, published by the European Directorate for the Quality of Medicines, and was illustrated on eye drops. We developed five dimensions in support of the risk assessment including intrinsic, extrinsic and potential risks of counterfeiting. The five criteria were integrated in a comprehensively weighted risk-scoring format. The probability of procuring the product from the internet was also assessed based on the number of relevant links within the first twenty search engine results and the cost of the products. With the application of the tool a dorzolamide & timolol combination eye drop represented the highest overall patient safety risk score. In consideration of our literature review of the past 20 years, there is no current, standardized methodology to effectively identify pharmaceutical products associated with high patient safety risks. Notably, the fully comprehensive analysis of the internet pharmaceutical market and the test purchase of all online available medicines is unrealistic. Therefore, we developed a method to aid online surveillance researches and targeted international organizational led joint actions against the uncontrolled sale of falsified and substandard medications (e.g.: Operation Pangea).
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Affiliation(s)
- Róbert György Vida
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Honvéd Street 3, 7624 Pécs, Hungary
- Corresponding author.
| | - Sára Merczel
- Department of Pharmacy, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, 7400 Kaposvár, Hungary
| | - Eszter Jáhn
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Honvéd Street 3, 7624 Pécs, Hungary
| | - András Fittler
- University of Pécs, Faculty of Pharmacy, Department of Pharmaceutics and Central Clinical Pharmacy, Honvéd Street 3, 7624 Pécs, Hungary
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15
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Kimmel SD, Miller NS. The Clinical Microbiology Laboratory and the Opioid Epidemic: Challenges and Opportunities. Infect Dis Clin North Am 2020; 34:465-478. [PMID: 32782096 PMCID: PMC7428057 DOI: 10.1016/j.idc.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Increased infections from injection drug use harm patients and are costly to the health care system. The impact on clinical microbiology laboratories is less recognized. Microbiology laboratories face increased test volume and test complexity from the spectrum and burden of pathogens associated with injection drug use, which lead to diagnostic challenges and overtaxed resources. We describe stressed workflows, pathogens that defy protocols, and limits of current technologies. Laboratories may benefit from protocol revisions, additional resources, workflow oversight, and improved communication with clinical providers to optimally meet challenges associated with this public health crisis.
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Affiliation(s)
- Simeon D Kimmel
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA; Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA.
| | - Nancy S Miller
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston University School of Medicine, 670 Albany Street, Suite 733, Boston, MA 02118, USA
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Khoury MK, Heid CA, Cripps MW, Pickett ML, Nagaraj MB, Johns M, Lee F, Hennessy SA. Antifungal Therapy in Fungal Necrotizing Soft Tissue Infections. J Surg Res 2020; 256:187-192. [PMID: 32711174 DOI: 10.1016/j.jss.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies associated with high morbidity and mortality. Fungal NSTIs are considered rare and have been largely understudied. The purpose of this study was to study the impact of fungal NSTIs and antifungal therapy on mortality after NSTIs. METHODS A retrospective chart review was performed on patients with NSTIs from 2012 to 2018. Patient baseline characteristics, microbiologic data, antimicrobial therapy, and clinical outcomes were collected. Patients were excluded if they had comfort care before excision. The primary outcome measured was in-hospital mortality. RESULTS A total of 215 patients met study criteria with a fungal species identified in 29 patients (13.5%). The most prevalent fungal organism was Candida tropicalis (n = 11). Fungal NSTIs were more prevalent in patients taking immunosuppressive medications (17.2% versus 3.2%, P = 0.01). A fungal NSTI was significantly associated with in-hospital mortality (odds ratio, 3.13; 95% confidence interval, 1.16-8.40; P = 0.02). Furthermore, fungal NSTI patients had longer lengths of stay (32 d [interquartile range, 16-53] versus 19 d [interquartile range, 11-31], P < 0.01), more likely to require initiation of renal replacement therapy (24.1% versus 8.6%, P = 0.02), and more likely to require mechanical ventilation (64.5% versus 42.0%, P = 0.02). Initiation of antifungals was associated with a significantly lower rate of in-hospital mortality (6.7% versus 57.1%, P = 0.01). CONCLUSIONS Fungal NSTIs are more common in patients taking immunosuppressive medications and are significantly associated with in-hospital mortality. Antifungal therapy is associated with decreased in-hospital mortality in those with fungal NSTIs. Consideration should be given to adding antifungals in empiric treatment regimens, especially in those taking immunosuppressive medications.
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Affiliation(s)
- Mitri K Khoury
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas; Division of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Christopher A Heid
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael W Cripps
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Maryanne L Pickett
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Madhuri B Nagaraj
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Meagan Johns
- Division of Pharmacologic Sciences, Department of Biomedical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Francesca Lee
- Department of Internal Medicine and Pathology, UT Southwestern Medical Center, Dallas, Texas
| | - Sara A Hennessy
- Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
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Vasylyeva TI, Smyrnov P, Strathdee S, Friedman SR. Challenges posed by COVID-19 to people who inject drugs and lessons from other outbreaks. J Int AIDS Soc 2020; 23:e25583. [PMID: 32697423 PMCID: PMC7375066 DOI: 10.1002/jia2.25583] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In light of the COVID-19 pandemic, considerable effort is going into identifying and protecting those at risk. Criminalization, stigmatization and the psychological, physical, behavioural and economic consequences of substance use make people who inject drugs (PWID) extremely vulnerable to many infectious diseases. While relationships between drug use and blood-borne and sexually transmitted infections are well studied, less attention has been paid to other infectious disease outbreaks among PWID. DISCUSSION COVID-19 is likely to disproportionally affect PWID due to a high prevalence of comorbidities that make the disease more severe, unsanitary and overcrowded living conditions, stigmatization, common incarceration, homelessness and difficulties in adhering to quarantine, social distancing or self-isolation mandates. The COVID-19 pandemic also jeopardizes essential for PWID services, such as needle exchange or substitution therapy programmes, which can be affected both in a short- and a long-term perspective. Importantly, there is substantial evidence of other infectious disease outbreaks in PWID that were associated with factors that enable COVID-19 transmission, such as poor hygiene, overcrowded living conditions and communal ways of using drugs. CONCLUSIONS The COVID-19 crisis might increase risks of homelessnes, overdoses and unsafe injecting and sexual practices for PWID. In order to address existing inequalities, consultations with PWID advocacy groups are vital when designing inclusive health response to the COVID-19 pandemic.
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18
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Hand and Upper Extremity Infections in Intravenous Drug Users: Epidemiology and Predictors of Outcomes. J Hand Surg Am 2020; 45:503-511. [PMID: 32229054 DOI: 10.1016/j.jhsa.2020.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 12/28/2019] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Injectable drug use (IDU) is a national epidemic, public health problem, and common cause of hand and upper extremity (UE) infections. This study assesses the epidemiology of the IDU patient population presenting to a Midwestern academic medical center emergency department (ED) and examines predictors influencing morbidity and outcomes. METHODS A retrospective review was performed using International Classification of Diseases, Ninth Revision (ICD-9) codes to identify all adult patients presenting to the ED with hand/UE infections, with and without concurrent IDU diagnoses, over a period of 2.5 years. Demographics and clinical factors were examined utilizing bivariate and multivariable analyses to identify predictors of outcomes, including not completing outpatient follow-up and leaving against medical advice (AMA). RESULTS A total of 1,482 patients with 1,754 ED visits for hand/UE infections were identified, including 308 patients with IDU-acquired infections (396 visits) and 1,174 patients with non-IDU infections (1,358 visits). Psychiatric comorbidities and hepatitis C were common in the IDU group (51% and 39%, respectively), and 31% of IDU patients were uninsured. Heroin use was identified in 96% of visits. The IDU infections were more likely to have surgical intervention than those in non-IDU patients (16% vs 6%), and a longer mean length hospital stay (2.4 vs 0.9 days). The IDU patients were more likely than non-IDU patients to leave AMA. In multivariable analysis, IDU, psychiatric comorbidity, and insurance status were independent predictors (P < .05) for leaving AMA. CONCLUSIONS In the setting of a national epidemic, hand/UE infections due to IDU are a common problem seen by hand surgeons. This study characterizes the growing IDU patient population at an urban academic medical center, examining the largest cohort of these patients to date. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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19
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Endogenous endophthalmitis and other ocular manifestations of injection drug use. Curr Opin Ophthalmol 2019; 30:506-512. [PMID: 31589187 DOI: 10.1097/icu.0000000000000606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The United States has experienced a dramatic rise in opioid and injection drug use over the past 2 decades. A public health emergency was declared in 2017 and subsequently, there have been several new reports on the rise of endogenous endophthalmitis specifically associated with injection drug use. The purpose of this review is to provide a current perspective of the ocular harms posed by injection drug use. RECENT FINDINGS The opioid epidemic has prompted several new studies from New England, one of the US regions most heavily affected, that examine the trends and characteristics of injection drug use-associated endogenous endophthalmitis. Patients may delay seeking care and may be infected with a variety of rare and atypical microbes, and as a result clinical appearance may vary widely. Injection drug use also leads to embolic phenomena such as talc retinopathy and septic emboli from endocarditis. HIV is highly associated with injection drug use and although HAART has drastically reduced the morbidity and mortality of HIV-associated infections, a variety of ocular disease may accompany an immunocompromised patient. SUMMARY Healthcare providers must remain vigilant in the recognition of injection drug use patients with vision loss and ocular inflammation to ensure prompt medical and/or surgical treatment.
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20
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Wylie SC, Cullum C, Brarens R. Considerations in the Diagnosis and Management of Lower-Extremity Infections in Injection Heroin Users: A Case Series. J Am Podiatr Med Assoc 2019; 109:437-444. [PMID: 31755766 DOI: 10.7547/17-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND On a national level, heroin-related hospital admissions have reached an all-time high. With the foot being the fourth most common injection site, heroin-related lower-extremity infections have become more prevalent owing to many factors, including drug preparation, injection practices, and unknown additives. METHODS We present a 16-month case series in which eight patients with lower-extremity infections secondary to heroin abuse presented to The Jewish Hospital in Cincinnati, Ohio. RESULTS Three cases of osteomyelitis were seen. All of the infections were cultured and yielded a wide array of microbes, including Staphyloccoccus, Streptococcus, Bacillus, Serratia, Prevotella, and Eikenella. All of the patients were treated with intravenous antibiotic agents, with nearly all receiving combination therapy. Seven of the eight patients underwent surgery during their hospital stay, with two undergoing amputation. Only half of the patients followed up after discharge. CONCLUSIONS This case series brings to light many considerations in the diagnosis and management of the heroin user, including multivariable attenuation of immunity, existing predisposition to infection backed by unsterile drug preparation and injection practices, innocuous presentation of deep infections, microbial spectrum, and recommendations on antimicrobial intervention, noncompliance, and poor follow-up. By having greater knowledge in unique considerations of diagnosis and treatment, more efficient care can be provided to this unique patient population.
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Affiliation(s)
- Sadie C. Wylie
- Department of Podiatric Medicine and Surgery, The Jewish Hospital–Mercy Health, Cincinnati, OH
| | - Christopher Cullum
- Department of Podiatric Medicine and Surgery, The Jewish Hospital–Mercy Health, Cincinnati, OH
| | - Robert Brarens
- Department of Podiatric Medicine and Surgery, The Jewish Hospital–Mercy Health, Cincinnati, OH
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Nymoen Aasbrenn M, Skeie I, Berild D. Compliance to antibiotic guidelines leads to more appropriate use of antibiotics in skin and soft tissue infections in injecting drug users. Infect Dis (Lond) 2019; 51:570-577. [PMID: 31144548 DOI: 10.1080/23744235.2019.1617435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Knowledge about the treatment of skin and soft tissue infections in injecting drug users in countries with a low prevalence of antibiotic resistance is limited. We investigated bacterial antibiotic resistance and treatment of skin and soft tissue infections in Norwegian drug users. Methods: We performed a two year clinical cross-sectional observational study in a Norwegian hospital. Data were collected retrospectively from hospital records. We examined bacteriological findings and antibiotic resistance, and evaluated compliance to treatment guidelines and appropriateness of empirical antibiotic therapy relative to results of cultures and susceptibility testing. Descriptive and univariate analyses were performed. Results: Hundred and thirty-five injecting drug users were admitted with skin and soft tissue infection in the study period. Cultures were obtained from 103 (77%) abscesses and eight (24%) erysipelas and cellulitis, with bacterial growth in 80 (78%) and five (63%), respectively. Streptococci and staphylococci were the most prevalent bacteria, but methicillin-resistant Staphylococcus aureus was found in only one patient. Compliance to hospital antibiotic guidelines was 70%. Ninety-one per cent of patients in the compliant and 79% in the non-compliant group were given effective empirical antibiotics (p = .334). In the non-compliant group, significantly more patients received broad-spectrum empirical antibiotics (p < .001). In 30 cases where adjustment of antibiotic therapy was possible according to susceptibility testing, this was performed in only 14 cases. Conclusions: Bacteria and resistance patterns did not differ significantly from the skin and soft tissue infections in the general population in Norway. Compliance to antibiotic guidelines led to significantly less use of broad-spectrum antibiotics and to good bacterial coverage. General guidelines for treatment should be applied to injecting drug users with skin and soft tissue infections.
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Affiliation(s)
- Marit Nymoen Aasbrenn
- a Department of Community Medicine , Faculty of Health Sciences, UiT The Arctic University of Norway , Tromsø , Norway
| | - Ivar Skeie
- b Innlandet Hospital Trust , Gjøvik , Norway.,c The Norwegian Centre for Addiction Research, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Dag Berild
- d Department of Infectious Diseases , Oslo University Hospital , Oslo , Norway.,e Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
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22
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Janssen E, Shah J, Néfau T, Cadet-Taïrou A. Age of Initiation and Patterns of Use among People Who Inject Drugs Welcomed in Harm Reduction Facilities in France from 2006 to 2015. J Psychoactive Drugs 2019; 51:260-271. [PMID: 30704351 DOI: 10.1080/02791072.2019.1567960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This exploratory analysis of time-series cross-sectional data provides insights on trends in age at first injection among people who inject drugs in France, and on associations with recent risky injecting behaviors. Data were collected from a national survey conducted in harm reduction facilities in five phases between 2006 and 2015. Standardized questionnaires collected information on demographics, substance use, and route of administration, as well as lifetime and past-month injection. Descriptive and multilevel models were applied to account for the hierarchical structure of the data. Prevalence of lifetime and past-month injection remained stable over time, while the prevalence of daily injection increased significantly. Mean age at first injection only appeared to increase for data collected after 2010. Gender differences in mean age at first injection decreased over time, suggesting the development of converging patterns of initiation independent of sex. After controlling for covariates, early initiation of injection was unrelated to daily injection or material sharing, and associated with the number of recently injected substances. Early initiation is likely a predictor of injected polysubstance use. Findings are relevant to the planning, implementation, and evaluation of prevention programs.
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Affiliation(s)
- Eric Janssen
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
| | - Jalpa Shah
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
| | - Thomas Néfau
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
| | - Agnès Cadet-Taïrou
- a French Monitoring Centre for Drugs and Drug Addictions, Observatoire Français des Drogues et Toxicomanies (OFDT) , La Plaine Saint Denis Cedex , France
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23
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A Review of Infections in People Who Use Nonprescription Drugs. CANADIAN JOURNAL OF ADDICTION 2018. [DOI: 10.1097/cxa.0000000000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schuch-Goi SB, Scherer JN, Kessler FHP, Sordi AO, Pechansky F, von Diemen L. Hepatitis C: clinical and biological features related to different forms of cocaine use. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 39:285-292. [PMID: 29267513 DOI: 10.1590/2237-6089-2016-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is related with several liver diseases such as cirrhosis and hepatocellular carcinomas, leading to more than 0.5 million deaths every year and to a great global burden. It is known that injection drug users show a high prevalence of HCV infection, being considered a risk group for this disease. Cocaine users seem to be in greater risk than other drug users, and several hypotheses for this association are being studied. AIM To review data on HCV infection in cocaine users, taking into consideration the relevance of the different routes of drug administration and other risk behaviors. METHODS This was a narrative review performed in the main scientific databases. RESULTS AND CONCLUSION Data suggest that cocaine use could be associated with HCV infection due to the specificities of cocaine consumption pattern, even in those subjects who do not inject drugs, in addition to other risky behaviors, such as tattooing and unprotected sex. Injectable cocaine users seem to be more susceptible to contamination than users who do not inject drugs. However, evidence is pointing to the possibility of infection by sharing drug paraphernalia other than syringes. Moreover, specific immune system impairments caused by cocaine use are also being linked with HCV infection susceptibility, persistence and increased pathological effects.
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Affiliation(s)
- Silvia Bassani Schuch-Goi
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliana Nichterwitz Scherer
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Anne Orgler Sordi
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisas em Álcool e Drogas, Centro Colaborador em Álcool e Drogas HCPA/SENAD, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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A Rare Case of Burkholderia cepacia Complex Septic Arthritis. Case Rep Infect Dis 2018; 2018:6232760. [PMID: 30305968 PMCID: PMC6165602 DOI: 10.1155/2018/6232760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022] Open
Abstract
Bacteria of the Burkholderia cepacia complex have rarely been reported to cause septic arthritis. Cases have been reported in patients who were immunocompromised, at extremes of age or who had history of steroid injection or penetrating trauma. A 67-year-old man with a history of opioid use disorder, osteoarthritis, and gout but no known immunocompromise was admitted to hospital with pain and swelling of his right knee. Cultures of synovial fluid and urine grew Burkholderia cepacia complex. Microscopy of synovial fluid also identified intracellular calcium pyrophosphate crystals. The patient's symptoms improved with joint irrigation and debridement and prolonged antimicrobial therapy. This case highlights the importance of diagnostic aspiration of an acutely inflamed joint to obtain a specific etiological diagnosis.
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Alemi F, Avramovic S, Schwartz MD. Electronic Health Record-Based Screening for Substance Abuse. BIG DATA 2018; 6:214-224. [PMID: 30283729 PMCID: PMC6154440 DOI: 10.1089/big.2018.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Existing methods of screening for substance abuse (standardized questionnaires or clinician's simply asking) have proven difficult to initiate and maintain in primary care settings. This article reports on how predictive modeling can be used to screen for substance abuse using extant data in electronic health records (EHRs). We relied on data available through Veterans Affairs Informatics and Computing Infrastructure (VINCI) for the years 2006 through 2016. We focused on 4,681,809 veterans who had at least two primary care visits; 829,827 of whom had a hospitalization. Data included 699 million outpatient and 17 million inpatient records. The dependent variable was substance abuse as identified from 89 diagnostic codes using the Agency for Healthcare Quality and Research classification of diseases. In addition, we included the diagnostic codes used for identification of prescription abuse. The independent variables were 10,292 inpatient and 13,512 outpatient diagnoses, plus 71 dummy variables measuring age at different years between 20 and 90 years. A modified naive Bayes model was used to aggregate the risk across predictors. The accuracy of the predictions was examined using area under the receiver operating characteristic (AROC) curve in 20% of data, randomly set aside for the evaluation. Many physical/mental illnesses were associated with substance abuse. These associations supported findings reported in the literature regarding the impact of substance abuse on various diseases and vice versa. In randomly set-aside validation data, the model accurately predicted substance abuse for inpatient (AROC = 0.884), outpatient (AROC = 0.825), and combined inpatient and outpatient (AROC = 0.840) data. If one excludes information available after substance abuse is known, the cross-validated AROC remained high, 0.822 for inpatient and 0.817 for outpatient data. Data within EHRs can be used to detect existing or predict potential future substance abuse.
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Affiliation(s)
- Farrokh Alemi
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
- Address correspondence to: Farrokh Alemi, Health Informatics Program, Department of Health Administration and Policy, George Mason University 1J3, 4400 University Drive, Fairfax, VA 22030,
| | - Sanja Avramovic
- Health Informatics Program, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Mark D. Schwartz
- Department of Population Health, New York University School of Medicine, New York, New York
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Aghababaei R, Javadi I, Nili-Ahmadabadi A, Parsafar S, Ahmadimoghaddam D. Occurrence of bacterial and toxic metals contamination in illegal opioid-like drugs in Iran: a significant health challenge in drug abusers. Daru 2018; 26:77-83. [PMID: 30159760 PMCID: PMC6154484 DOI: 10.1007/s40199-018-0205-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 03/18/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The toxic metals and/or bacterial contaminants in illicit drugs are the main health problems in drug users worldwide. Hence, the potential risks of these contaminants were evaluated in some of the illicit drugs during 2015 and 2016. METHODS The metals analysis were performed using graphite furnace atomic absorption spectrophotometry. In addition, all microbiological analysis stages, including handling procedures, dilution, and culture media, were conducted in accordance with the US Pharmacopeia (USP) which are harmonized with the European Pharmacopoeia (EP). RESULTS In the present study, the highest lead (Pb; 138.10 ± 75.01 μg/g) and chromium (Cr; 447.38 ± 20.27 μg/g) levels were detected in opium samples. In addition, the highest prevalence of microbial contamination was observed in opium samples, and the lowest was recorded in heroin samples. Clostridium tetani, with about 50% of contaminant, was the most common bacteria in the analyzed samples. CONCLUSIONS Our results indicate that Pb exposure as well as bacterial contamination could be the major threats for drug users. Graphical Abstract ᅟ.
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Affiliation(s)
- Rassoul Aghababaei
- Department of Toxicology, Faculty of Pharmacy, Islamic Azad University, Shahreza Branch, Shahreza, Iran
| | - Iraj Javadi
- Department of Toxicology, Faculty of Pharmacy, Islamic Azad University, Shahreza Branch, Shahreza, Iran
| | - Amir Nili-Ahmadabadi
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, P.O. Box 8678-3-65178, Hamadan, Iran
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Somayeh Parsafar
- Department of Microbiology, Islamic Azad University, Falavarjan Branch, Isfahan, Iran
| | - Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, P.O. Box 8678-3-65178, Hamadan, Iran
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Wurcel AG, Burke D, Skeer M, Landy D, Heimer R, Wong JB, Chui KKH, Stopka TJ. Sex work, injection drug use, and abscesses: Associations in women, but not men. Drug Alcohol Depend 2018; 185:293-297. [PMID: 29482054 PMCID: PMC5991097 DOI: 10.1016/j.drugalcdep.2017.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Abscesses commonly occur among people who inject drugs (PWID). However, whether the risks are comparable between males and females, and the impact of sex work on abscess risk is unclear. The goal of this study was to examine the contemporary associations of gender and sex work with the risk of abscesses in PWID. METHODS Combining data from two cross-sectional studies conducted in the Greater Boston Area with people at risk for HIV and hepatitis C virus (HCV), we used the following inclusion criteria: age 18-45 years and report of illicit or non-prescription drug injection within the 30 days prior to the survey. Information on demographics, injection-mediated risks, and sexual behaviors was collected using Audio Computer-Assisted Self-Interview Software. Multivariable logistic regressions were used to model associations. RESULTS The study sample included 298 people including 30% were female. Females were more likely than men to report sex work (28% vs. 16%, p = .012) and abscess during their lifetime (55% vs. 37% p = .004). Among the females, engaging in sex work increased by >5-fold the odds of reporting abscesses [Adjusted odds ratio 5.42; 95% CI: 1.27, 23.10]. There was no association between sex work and abscesses among men. DISCUSSION We found a female-specific association between sex work, injection drug use, and abscesses among PWID. Although the cross-sectional designs precluded causal inferences, longitudinal studies could enhance understanding of gender-associated risks for abscesses and inform the development of harm reduction interventions.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Deirdre Burke
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States
| | - Margie Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - David Landy
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Kenneth K. H. Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
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Isolation and whole genome analysis of endospore-forming bacteria from heroin. Forensic Sci Int Genet 2018; 32:1-6. [DOI: 10.1016/j.fsigen.2017.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 11/17/2022]
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Agochukwu N, Boustany A, Rinker B. Late breast implant infections: a delayed MRSA infection from hematogenous spread in an intravenous drug user. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1362-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths. Daru 2017. [DOI: doi 10.1186/s40199-017-0170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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32
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Akhgari M, Mobaraki H, Etemadi-Aleagha A. Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths. Daru 2017. [DOI: https://doi.org/10.1186/s40199-017-0170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Akhgari M, Mobaraki H, Etemadi-Aleagha A. Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths. ACTA ACUST UNITED AC 2017; 25:5. [PMID: 28212679 PMCID: PMC5316196 DOI: 10.1186/s40199-017-0170-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Methamphetamine abuse is a worldwide health concern. Methamphetamine causes health hazards in many vital organs. It can cause damage to cardiac tissue via catecholamines release. Methamphetamine related deaths are becoming one of the most important problems in Iran. The purpose of the present study was to determine cardiac pathology in methamphetamine poisoning-related deaths. METHODS The study included 100 cases of methamphetamine poisoning-related deaths and 100 cases as control group. Toxicology analysis of liver, gastric content, bile, urine, blood and vitreous humor were conducted to detect drugs, poisons and alcohols using thin layer chromatography, gas chromatography/mass spectrometry, and high performance liquid chromatography. Positive toxicology analysis results except for amphetamine and methamphetamine were excluded from the study in order to omit interfering factors. The most striking features of cardiac damage were observed by light microscopy. RESULTS Methamphetamine and amphetamine were detected in either urine or gastric content samples. In all of the cases methamphetamine toxicity was determined to be a direct cause of death by forensic medicine practitioner. Cardiovascular pathology was noted in 68% of studied cases. The most common histopathologic features were myocardial fiber hypertrophy, mild, moderate to severe atherosclerosis and focal degeneration/necrosis. CONCLUSION The results of the present study indicate that cardiotoxicity is one of the major contributing factors in methamphetamine poisoning related deaths. Overall, the current study highlights the fact that cardiotoxic effects of methamphetamine can explain increasing reports of heart failure and consequently death in young abusers. TRIAL REGISTRATION Not applicable. Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths.
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Affiliation(s)
- Maryam Akhgari
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Old Ghom Road, 500 meters after Beheste Zahra, 1816153141, Tehran, Iran.
| | - Homeira Mobaraki
- Department of Forensic Pathology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Oosterhoff B, Shook NJ. From drug laws to recreational substance use: The adaptationist role of disgust sensitivity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Casarin M, Antoniazzi RP, Vaucher RA, Feldens CA, Zanatta FB. RT-PCR quantification of periodontal pathogens in crack users and non-users. Oral Dis 2016; 23:324-330. [DOI: 10.1111/odi.12609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 10/07/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M Casarin
- Postgraduate Program in Dentistry; Federal University of Santa Maria; Santa Maria Brazil
| | - RP Antoniazzi
- Dentistry Course; Franciscan University Center; Santa Maria Brazil
| | - RA Vaucher
- Postgraduate Program in Biochemistry and Bioprospecting; Center of Chemistry; Pharmaceutical and Food Science; Federal University of Pelotas (UFPel); Pelotas Rio Grande do Sul Brazil
| | - CA Feldens
- Postgraduate Program in Dentistry; Lutheran University of Brazil; Canoas Brazil
| | - FB Zanatta
- Postgraduate Program in Dentistry; Federal University of Santa Maria; Santa Maria Brazil
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Nielsen B. Imitations and Transformations: On Side Effects of the ADHD Epidemic. Med Anthropol 2016; 36:246-259. [PMID: 27673707 DOI: 10.1080/01459740.2016.1239618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The attention deficit hyperactivity disorder epidemic has been the subject of much scrutiny, especially in relation to the medicalization of children, and, to a lesser degree, to the use of Ritalin as a performance enhancer or party drug (e.g., Keane 2008; Whitaker 2010; Bowden 2013). In this article, my focus is on non-investigated side effects of this epidemic, namely the use of (prescription) Ritalin among heavy drug users. Based on fieldwork conducted in one of the largest cities in Denmark, in this article I trace the spread of intravenous use of Ritalin, and examine how different ways of ingesting Ritalin transform the drug itself, and, with this, transform treatment practices, parts of the drug scene, and the bodies of users. In my analysis, I draw on insights from anthropological theories on imitation and from material semiotics.
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Affiliation(s)
- Bjarke Nielsen
- a Centre for Alcohol and Drug Research , Aarhus University , Aarhus , Denmark
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37
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Roy É, Arruda N, Bertrand K, Dufour M, Laverdière É, Jutras-Aswad D, Perreault M, Berbiche D, Bruneau J. Prevalence and correlates of prescription opioid residue injection. Drug Alcohol Depend 2016; 166:69-74. [PMID: 27397582 DOI: 10.1016/j.drugalcdep.2016.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is growing evidence of intravenous administration of prescription opioids (POs) in several countries. Preparation of POs for injection may leave residues in containers and filters used by people who inject drugs and may lead to adverse health outcomes if they are injected. METHODS This exploratory study used cross-sectional data from the COSMO study, a prospective cohort of out-of-treatment cocaine users carried out in Montréal (Canada) between October 2010 and August 2015. For this analysis, only one visit per participant was selected, that is, the first time the participant reported PO injection during the study. The outcome of interest, "injection of PO residues", was defined as having injected PO residues from a filter and/or a container in the last month. Correlates of this outcome were identified using logistic regression analyses. RESULTS Of the 122 participants who reported PO injection during the study period, 41.8% had injected PO residues. Reporting an unstable source of income (AOR=4.26; 95% CI: 1.03-17.69), a recent overdose (AOR=5.45; 95% CI: 1.50-19.88) and a preponderant use of opiates (mostly opiate use versus other drugs excluding alcohol and cannabis) (AOR=2.46; 95% CI: 1.08-5.63) increased the risk of PO residue injection. The odds of reporting PO residue injection rose by 7% per unit increase in the score of psychological distress (AOR=1.07 per unit increase; 95% CI: 1.01-1.12). CONCLUSIONS The findings of this study suggest that PO residue injection is associated with markers of vulnerability. Further investigation is needed in order to better understand this understudied drug injection practice.
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Affiliation(s)
- Élise Roy
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada; Institut national de santé publique du Québec, Montréal, Québec, Canada.
| | - Nelson Arruda
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Karine Bertrand
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Magali Dufour
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Émélie Laverdière
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Michel Perreault
- Douglas Mental Health Institute, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Djamal Berbiche
- Faculty of Medecine and Health Sciences, Charles-Le Moyne Hospital Research Centre, Longueuil, Québec, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Department of Family Medecine, Université de Montréal, Montréal, Québec, Canada
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Dugosh KL, Festinger DS, Lipkin JL. Identifying and Addressing the Unmet Health Care Needs of Drug Court Clients. J Subst Abuse Treat 2016; 71:30-35. [PMID: 27776674 DOI: 10.1016/j.jsat.2016.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022]
Abstract
Drug courts address issues such as employment and housing but largely miss the opportunity to address important health care issues. The current study examined the prevalence and correlates of chronic medical conditions among a sample of drug court clients who were participating in a clinical trial of an intervention to reduce HIV risk. A total of 256 clients completed a health survey at entry into the drug court program and 9 months post-entry. The baseline health survey included a comprehensive list of chronic medical conditions, and participants were asked to indicate which, if any, they had ever been diagnosed as having. They were also asked to indicate whether or not they were currently receiving treatment for each chronic condition that they endorsed. The follow-up survey was identical to the baseline survey, with the exception that it contained items reflecting (1) whether or not any member of the drug court team engaged in discussion with the client about each of the chronic conditions reported and (2) whether the client received a referral to medical care for endorsed conditions while in the drug court program. Results indicated that over 50% of clients reported at least one chronic condition and 21% reported more than one condition. Among those with chronic conditions, 71% reported having chronic conditions for which they were not currently receiving treatment. Unfortunately, drug court clients reported that the drug court team did little to address these unmet health needs. Findings from this study suggest that clients could benefit if drug court programs began to widen their focus to include addressing health-related issues.
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Affiliation(s)
- Karen L Dugosh
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States.
| | - David S Festinger
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
| | - Jessica L Lipkin
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA 19106, United States
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Hartman L, Barnes E, Bachmann L, Schafer K, Lovato J, Files DC. Opiate Injection-associated Infective Endocarditis in the Southeastern United States. Am J Med Sci 2016; 352:603-608. [PMID: 27916215 DOI: 10.1016/j.amjms.2016.08.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/08/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opiate pain reliever (OPR) misuse by injection is increasing in the United States. Infective endocarditis (IE), a devastating complication of injection OPR use, has been understudied. METHODS We conducted a retrospective chart review of IE cases at an academic tertiary care hospital in North Carolina. Hospital admissions from 2009-2014 were screened for cases of definite IE. Subjects reporting injection drug use (IDU) were classified as IDU-IE, and compared to those without reported IDU, classified as No IDU-IE. Rates of IDU-IE and No IDU-IE, patient demographics, microbiologic data and outcomes were compared between the groups. RESULTS A total of 127 incident admissions for IE were identified, 48 (37.8%) were classified as IDU-IE and 79 (62.2%) as No IDU-IE. IDU-IE cases increased from 14% of hospitalizations for IE in 2009 to 56% in 2014; reporting of OPR injection increased in 2012 and continued through the study period. IDU-IE subjects were younger (32.6 ± 11.7 versus 54.4 ± 13.1, P < 0.0001), more likely to be single (n = 33 [68.8%] versus n = 23 [29.1%], P < 0.0001) and to reside in rural communities (n = 36 [75.0%] versus n = 25 [31.6%], P < 0.0001) than No IDU-IE subjects. Hospital length of stay (26 days versus 12 days, P < 0.0001) and intensive care unit length of stay (2 days versus 1 day, P = 0.04) were longer for IDU-IE patients and hospital mortality did not differ (10.4% IDU-IE versus 8.9% No IDU-IE, P = 0.77). CONCLUSIONS IDU-IE rates increased over time, and OPR injection use in rural communities appears to be a major contributor. Interventions to reduce IDU-IE and OPR misuse are needed to halt this growing epidemic in at-risk rural communities.
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Affiliation(s)
- Lauren Hartman
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Erin Barnes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laura Bachmann
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine Schafer
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Lovato
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel Clark Files
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC; Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Piepenbrink MS, Samuel M, Zheng B, Carter B, Fucile C, Bunce C, Kiebala M, Khan AA, Thakar J, Maggirwar SB, Morse D, Rosenberg AF, Haughey NJ, Valenti W, Keefer MC, Kobie JJ. Humoral Dysregulation Associated with Increased Systemic Inflammation among Injection Heroin Users. PLoS One 2016; 11:e0158641. [PMID: 27379802 PMCID: PMC4933366 DOI: 10.1371/journal.pone.0158641] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/20/2016] [Indexed: 02/06/2023] Open
Abstract
Background Injection drug use is a growing major public health concern. Injection drug users (IDUs) have a higher incidence of co-morbidities including HIV, Hepatitis, and other infections. An effective humoral response is critical for optimal homeostasis and protection from infection; however, the impact of injection heroin use on humoral immunity is poorly understood. We hypothesized that IDUs have altered B cell and antibody profiles. Methods and Findings A comprehensive systems biology-based cross-sectional assessment of 130 peripheral blood B cell flow cytometry- and plasma- based features was performed on HIV-/Hepatitis C-, active heroin IDUs who participated in a syringe exchange program (n = 19) and healthy control subjects (n = 19). The IDU group had substantial polydrug use, with 89% reporting cocaine injection within the preceding month. IDUs exhibited a significant, 2-fold increase in total B cells compared to healthy subjects, which was associated with increased activated B cell subsets. Although plasma total IgG titers were similar between groups, IDUs had significantly higher IgG3 and IgG4, suggestive of chronic B cell activation. Total IgM was also increased in IDUs, as well as HIV Envelope-specific IgM, suggestive of increased HIV exposure. IDUs exhibited numerous features suggestive of systemic inflammation, including significantly increased plasma sCD40L, TNF-α, TGF-α, IL-8, and ceramide metabolites. Machine learning multivariate analysis distilled a set of 10 features that classified samples based on group with absolute accuracy. Conclusions These results demonstrate broad alterations in the steady-state humoral profile of IDUs that are associated with increased systemic inflammation. Such dysregulation may impact the ability of IDUs to generate optimal responses to vaccination and infection, or lead to increased risk for inflammation-related co-morbidities, and should be considered when developing immune-based interventions for this growing population.
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Affiliation(s)
- Michael S. Piepenbrink
- Infectious Diseases Division, Department of Medicine, University of Rochester, Rochester, NY, United States of America
| | - Memorie Samuel
- School of Medicine, Howard University, Washington, DC, United States of America
| | - Bo Zheng
- Infectious Diseases Division, Department of Medicine, University of Rochester, Rochester, NY, United States of America
| | - Brittany Carter
- School of Medicine, Texas A&M University, Bryan, TX, United States of America
| | - Christopher Fucile
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, United States of America
| | - Catherine Bunce
- Infectious Diseases Division, Department of Medicine, University of Rochester, Rochester, NY, United States of America
| | - Michelle Kiebala
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States of America
| | - Atif A. Khan
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States of America
| | - Juilee Thakar
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States of America
| | - Sanjay B. Maggirwar
- Department of Microbiology and Immunology, University of Rochester, Rochester, NY, United States of America
| | - Diane Morse
- Departments of Psychiatry and Medicine, University of Rochester, Rochester, NY, United States of America
| | - Alexander F. Rosenberg
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, United States of America
| | - Norman J. Haughey
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States of America
| | - William Valenti
- Infectious Diseases Division, Department of Medicine, University of Rochester, Rochester, NY, United States of America
- Trillium Health, Rochester, NY, United States of America
| | - Michael C. Keefer
- Infectious Diseases Division, Department of Medicine, University of Rochester, Rochester, NY, United States of America
| | - James J. Kobie
- Infectious Diseases Division, Department of Medicine, University of Rochester, Rochester, NY, United States of America
- * E-mail:
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Thakarar K, Weinstein ZM, Walley AY. Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist. Postgrad Med J 2016; 92:356-63. [PMID: 27004476 PMCID: PMC4967553 DOI: 10.1136/postgradmedj-2015-133720] [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: 09/16/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
The opioid epidemic in the USA continues to worsen. Medical providers are faced with the challenge of addressing complications from opioid use disorders and associated injection drug use. Unsafe injection practices among people who inject drugs (PWID) can lead to several complications requiring acute care encounters in the emergency department and inpatient hospital. Our objective is to provide a narrative review to help medical providers recognise and address key health issues in PWID, who are being released from the emergency department and inpatient hospital. In the midst of rises in overdose deaths and infections such as hepatitis C, we highlight several health issues for PWID, including overdose and infection prevention. We provide a clinical checklist of actions to help guide providers in the care of these complex patients. The clinical checklist includes strategies also applicable to low-resource settings, which may lack addiction treatment options. Our review and clinical checklist highlight key aspects of optimising the health and safety of PWID.
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Affiliation(s)
- Kinna Thakarar
- Department of Medicine/Infectious Diseases, Maine Medical Center, Portland, Maine, USA
| | - Zoe M Weinstein
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
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Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman JM. Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs. Drug Alcohol Rev 2016; 35:611-9. [PMID: 27241554 DOI: 10.1111/dar.12392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Despite over-representation of Indigenous Australians in sentinel studies of injecting drug use, little is known about relevant patterns of drug use and dependence. This study compares drug dependence and possible contributing factors in Indigenous and non-Indigenous Australians who inject drugs. DESIGN AND METHODS Respondent-driven sampling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community sample of Indigenous (n = 282) and non-Indigenous (n = 267) injectors. Data are cross sectional. Multinomial models were developed for each group to examine types of dependence on injected drugs (no dependence, methamphetamine-dependent only, opioid-dependent only, dependent on methamphetamine and opioids). RESULTS Around one-fifth of Indigenous and non-Indigenous injectors were dependent on both methamphetamine and opioids in the previous 12 months. Psychological distress was associated with dual dependence on these drugs for Indigenous [adjusted relative risk (ARR) 4.86, 95% confidence interval (CI) 2.08-11.34] and non-Indigenous (ARR 4.14, 95% CI 1.59-10.78) participants. Unemployment (ARR 8.98, 95% CI 2.25-35.82) and repeated (> once) incarceration as an adult (ARR 3.78, 95% CI 1.43-9.97) were associated with dual dependence for Indigenous participants only. Indigenous participants had high rates of alcohol dependence, except for those dependent on opioids only. DISCUSSION AND CONCLUSIONS The drug dependence patterns of Indigenous and non-Indigenous people who inject drugs were similar, including the proportions dependent on both methamphetamine and opioids. However, for Indigenous injectors, there was a stronger association between drug dependence and contextual factors such as unemployment and incarceration. Expansion of treatment options and community-level programs may be required. [Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman J M. Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs. Drug Alcohol Rev 2016;35:611-619].
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Affiliation(s)
- Andrew Smirnov
- The University of Queensland, School of Public Health, Queensland Alcohol and Drug Research and Education Centre, Brisbane, Australia. .,Communicable Diseases Unit, Chief Health Officer Branch, Department of Health, Queensland Government, Brisbane, Australia.
| | - Robert Kemp
- Communicable Diseases Unit, Chief Health Officer Branch, Department of Health, Queensland Government, Brisbane, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Suzanna Henderson
- The University of Queensland, School of Public Health, Queensland Alcohol and Drug Research and Education Centre, Brisbane, Australia
| | - Sidney Williams
- Queensland Aboriginal and Islander Health Council, Brisbane, Australia
| | - Abhilash Dev
- Communicable Diseases Unit, Chief Health Officer Branch, Department of Health, Queensland Government, Brisbane, Australia
| | - Jake M Najman
- The University of Queensland, School of Public Health, Queensland Alcohol and Drug Research and Education Centre, Brisbane, Australia.,The University of Queensland, School of Social Science, Brisbane, Australia
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Yuen CM, Kammerer JS, Marks K, Navin TR, France AM. Recent Transmission of Tuberculosis - United States, 2011-2014. PLoS One 2016; 11:e0153728. [PMID: 27082644 PMCID: PMC4833321 DOI: 10.1371/journal.pone.0153728] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/01/2016] [Indexed: 01/20/2023] Open
Abstract
Tuberculosis is an infectious disease that may result from recent transmission or from an infection acquired many years in the past; there is no diagnostic test to distinguish the two causes. Cases resulting from recent transmission are particularly concerning from a public health standpoint. To describe recent tuberculosis transmission in the United States, we used a field-validated plausible source-case method to estimate cases likely resulting from recent transmission during January 2011-September 2014. We classified cases as resulting from either limited or extensive recent transmission based on transmission cluster size. We used logistic regression to analyze patient characteristics associated with recent transmission. Of 26,586 genotyped cases, 14% were attributable to recent transmission, 39% of which were attributable to extensive recent transmission. The burden of cases attributed to recent transmission was geographically heterogeneous and poorly predicted by tuberculosis incidence. Extensive recent transmission was positively associated with American Indian/Alaska Native (adjusted prevalence ratio [aPR] = 3.6 (95% confidence interval [CI] 2.9-4.4), Native Hawaiian/Pacific Islander (aPR = 3.2, 95% CI 2.3-4.5), and black (aPR = 3.0, 95% CI 2.6-3.5) race, and homelessness (aPR = 2.3, 95% CI 2.0-2.5). Extensive recent transmission was negatively associated with foreign birth (aPR = 0.2, 95% CI 0.2-0.2). Tuberculosis control efforts should prioritize reducing transmission among higher-risk populations.
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Affiliation(s)
- Courtney M. Yuen
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - J. Steve Kammerer
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kala Marks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas R. Navin
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anne Marie France
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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McLean S, Patel R, Bruno R. Injection of Pharmaceuticals Designed for Oral Use: Harms Experienced and Effective Harm Reduction Through Filtration. Curr Top Behav Neurosci 2016; 34:77-98. [PMID: 28401523 DOI: 10.1007/7854_2016_470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Several pharmaceutical products are liable to 'abuse' or use outside their prescription, which frequently involves their injection. Examples are slow-release forms of morphine and oxycodone, and sublingual buprenorphine. During injection preparation, the drug is extracted into water, after crushing and heating the tablet if considered necessary. Since these products are designed for oral administration, they can contain excipients (ingredients other than the drug) which are poorly soluble, resulting in suspension of particles in the injection solution. Injected particles are able to produce medical complications such as the blockage of small blood vessels leading to ischaemia (inadequate blood flow) and tissue damage. Filtration can be used to remove particles from the suspension; including bacteria if the porosity is small enough (0.2 μm). However, filters are liable to blockage when overloaded, especially if the pore size is small. This problem can be minimised by using a larger pore size (e.g. 5-10 μm), but the resulting filtrate will contain many residual small particles. The use of two filters, coarse and fine, either sequentially or in a double membrane device, enables removal of the majority of particles as well as bacteria, although not quite meeting pharmaceutical standards for safe injection. Although not yet evaluated by a clinical trial, this highly effective filtration process would be expected to greatly reduce the risk of vascular and related complications, as well as non-viral infections. Careful technique ensures that drug is not lost by filtration, a priority for most drug consumers. Practical issues that affect acceptability of filtration by injecting drug users, including ease of use and cost, will need to be considered. However, given the laboratory evidence demonstrating the effectiveness of filters it is time to consider these tools as essential for safe injection as sterile needles/syringes for the world's approximately 16 million people who inject drugs.
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Affiliation(s)
- Stuart McLean
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Rahul Patel
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Australia.
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Ng H, Patel RP, Bruno R, Latham R, Wanandy T, McLean S. Filtration of crushed tablet suspensions has potential to reduce infection incidence in people who inject drugs. Drug Alcohol Rev 2014; 34:67-73. [DOI: 10.1111/dar.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Huei Ng
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
| | - Rahul P. Patel
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
| | - Raimondo Bruno
- Division of Psychology; School of Medicine; University of Tasmania; Hobart Australia
| | - Roger Latham
- School of Medicine; University of Tasmania; Hobart Australia
| | - Troy Wanandy
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
- Pharmacy Department; Royal Hobart Hospital; Hobart Australia
| | - Stuart McLean
- Division of Pharmacy; School of Medicine; University of Tasmania; Hobart Australia
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Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- T Berger
- Israel Defense Force, Medical Corps, Ramat-Gan, Israel
- Department of Internal Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - M Kassirer
- Israel Defense Force, Medical Corps, Ramat-Gan, Israel
| | - A A Aran
- Israel Defense Force, Medical Corps, Ramat-Gan, Israel
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Pullirsch D, Bellemare J, Hackl A, Trottier YL, Mayrhofer A, Schindl H, Taillon C, Gartner C, Hottowy B, Beck G, Gagnon J. Microbiological contamination in counterfeit and unapproved drugs. BMC Pharmacol Toxicol 2014; 15:34. [PMID: 24965483 PMCID: PMC4088308 DOI: 10.1186/2050-6511-15-34] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Counterfeit and unapproved medicines are inherently dangerous and can cause patient injury due to ineffectiveness, chemical or biological contamination, or wrong dosage. Growth of the counterfeit medical market in developed countries is mainly attributable to life-style drugs, which are used in the treatment of non-life-threatening and non-painful conditions, such as slimming pills, cosmetic-related pharmaceuticals, and drugs for sexual enhancement. One of the main tasks of health authorities is to identify the exact active pharmaceutical ingredients (APIs) in confiscated drugs, because wrong API compounds, wrong concentrations, and/or the presence of chemical contaminants are the main risks associated with counterfeit medicines. Serious danger may also arise from microbiological contamination. We therefore performed a market surveillance study focused on the microbial burden in counterfeit and unapproved medicines. Methods Counterfeit and unapproved medicines confiscated in Canada and Austria and controls from the legal market were examined for microbial contaminations according to the US and European pharmacopoeia guidelines. The microbiological load of illegal and legitimate samples was statistically compared with the Wilcoxon rank-sum test. Results Microbial cultivable contaminations in counterfeit and unapproved phosphodiesterase type 5 inhibitors were significantly higher than in products from the legal medicines market (p < 0.0001). Contamination levels exceeding the USP and EP limits were seen in 23% of the tested illegal samples in Canada. Additionally, microbiological contaminations above the pharmacopoeial limits were detected in an anabolic steroid and an herbal medicinal product in Austria (6% of illegal products tested). Conclusions Our results show that counterfeit and unapproved pharmaceuticals are not manufactured under the same hygienic conditions as legitimate products. The microbiological contamination of illegal medicinal products often exceeds USP and EP limits, representing a potential threat to consumer health.
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Affiliation(s)
- Dieter Pullirsch
- AGES - Austrian Agency for Health & Food Safety, Austrian Medicines and Medical Devices Agency, Traisengasse 5, Vienna AT-1200, Austria.
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Hischebeth GTR, Keil VC, Gentil K, Boström A, Kuchelmeister K, Bekeredjian-Ding I. Rapid brain death caused by a cerebellar abscess with Fusobacterium nucleatum in a young man with drug abuse: a case report. BMC Res Notes 2014; 7:353. [PMID: 24915846 PMCID: PMC4062896 DOI: 10.1186/1756-0500-7-353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 06/03/2014] [Indexed: 11/13/2022] Open
Abstract
Background Fusobacterium nucleatum is a strict anaerobic microorganism that causes disease entities such as periodontal and soft tissue abscesses, pulmonary and intraabdominal infections and very rarely intracerebral infections. Case presentation Here, we report the rare case of a previously healthy 25-year-old German man with a cerebellar abscess caused by Fusobacterium nucleatum that resulted in rapid brain death. Toxicological screening showed positivity for amphetamines and cannabis. The diagnosis was obtained by polymerase chain reaction amplification of bacterial deoxyribonucleic acid in cerebrospinal fluid. Conclusions In drug users clinicians should think about rare causes of brain abscesses/meningitis. Early diagnosis is necessary and justifies the use of molecular techniques.
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Affiliation(s)
- Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str, 25, D-53127 Bonn, Germany.
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Residential addiction treatment for injection drug users requiring intravenous antibiotics: a cost-reduction strategy. J Addict Med 2014; 7:271-6. [PMID: 23648642 DOI: 10.1097/adm.0b013e318294b1eb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Injection drug users (IDUs) are prone to developing infections and complications requiring prolonged intravenous (IV) antibiotic treatment. Our institution's unique multidisciplinary approach provides special consideration and successful management of IDUs in a residential addiction treatment facility with nurse-administered IV antibiotics. Our hypothesis is that hospital costs can be reduced by providing both IV antibiotics and addiction treatment in a community residential treatment setting outside the hospital. METHODS A retrospective chart review was performed for inpatients requiring prolonged antibiotic treatment who were admitted to the university teaching hospital between January 2006 and December 2011 and were treated at the residential addiction treatment facility. Data were gathered to characterize this population of patients and estimate cost savings. RESULTS A total of 205 patients were sent to the residential addiction treatment facility from 2006 to 2011. The majority were African American, men, and in their early forties. Heroin was the most popular injected substance, but most patients were polysubstance users, including alcohol and tobacco. The most common infections were osteomyelitis and septic arthritis. There was a 73% completion rate of antibiotic treatment in this program. The relapse rate for return to illicit drug use was at least 32%. This program has resulted in a significant cost savings of $2.43 million in a 6-year period. CONCLUSIONS The program saved $2.43 million over 6 years for the health care system by reducing hospital length of stay with safe and appropriate discharge planning for IDUs with infections requiring long-term IV antibiotics.
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50
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Moretti S, Castelli M, Franchi S, Raggi MA, Mercolini L, Protti M, Somaini L, Panerai AE, Sacerdote P. Δ⁹-Tetrahydrocannabinol-induced anti-inflammatory responses in adolescent mice switch to proinflammatory in adulthood. J Leukoc Biol 2014; 96:523-34. [PMID: 24744434 DOI: 10.1189/jlb.3hi0713-406rr] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Marijuana abuse is prominent among adolescents. Although Δ(9)-THC, one of its main components, has been demonstrated to modulate immunity in adults, little is known about its impact during adolescence on the immune system and the long-lasting effects in adulthood. We demonstrate that 10 days of Δ(9)-THC treatment induced a similar alteration of macrophage and splenocyte cytokines in adolescent and adult mice. Immediately at the end of chronic Δ(9)-THC, a decrease of proinflammatory cytokines IL- 1β and TNF-α and an increase of anti-inflammatory cytokine IL-10 production by macrophages were present as protein and mRNA in adolescent and adult mice. In splenocytes, Δ(9)-THC modulated Th1/Th2 cytokines skewing toward Th2: IFN-γ was reduced, and IL-4 and IL-10 increased. These effects were lost in adult animals, 47 days after the last administration. In contrast, in adult animals treated as adolescents, a perturbation of immune responses, although in an opposite direction, was present. In adults treated as adolescents, a proinflammatory macrophage phenotype was observed (IL-1β and TNF-α were elevated; IL-10 decreased), and the production of Th cytokines was blunted. IgM titers were also reduced. Corticosterone concentrations indicate a long-lasting dysregulation of HPA in adolescent mice. We measured blood concentrations of Δ(9)-THC and its metabolites, showing that Δ(9)-THC plasma levels in our mice are in the order of those achieved in human heavy smokers. Our data demonstrate that Δ(9)-THC in adolescent mice triggers immune dysfunctions that last long after the end of abuse, switching the murine immune system to proinflammatory status in adulthood.
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Affiliation(s)
- Sarah Moretti
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Mara Castelli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Silvia Franchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Maria Augusta Raggi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Italy; and
| | - Laura Mercolini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Italy; and
| | - Michele Protti
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Italy; and
| | - Lorenzo Somaini
- Addiction Treatment Centre, Local Health Service, Cossato, Biella, Italy
| | - Alberto E Panerai
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Paola Sacerdote
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy;
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