Making Harm Reduction More Accessible: Fentanyl Test Strip Awareness and Attitudes among Emergency Department Patients Who Use Drugs

BACKGROUND

Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs.

METHODS

Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics.

RESULTS

Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices.

DISCUSSION

FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs.

Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults - United States, December 2020-March 2023

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline and the 3-month follow-up, from 98.4% to 48.2% for persons who received a positive SARS-CoV-2 test results (COVID test-positive participants) and from 88.2% to 36.6% for persons who received negative SARS-CoV-2 test results (COVID test-negative participants). Persistent symptoms decreased through 12 months; no difference between the groups was observed at 12 months (prevalence among COVID test-positive and COVID test-negative participants = 18.3% and 16.1%, respectively; p>0.05). Both groups reported symptoms that emerged or reemerged at 6, 9, and 12 months. Thus, these symptoms are not unique to COVID-19 or to post-COVID conditions. Awareness that symptoms might persist for up to 12 months, and that many symptoms might emerge or reemerge in the year after COVID-like illness, can assist health care providers in understanding the clinical signs and symptoms associated with post-COVID-like conditions.

Effect of COVID-19 Vaccine Messaging Platforms in Emergency Departments on Vaccine Acceptance and Uptake: A Cluster Randomized Clinical Trial

IMPORTANCE

Large segments of the US population's primary health care access occurs in emergency departments (EDs). These groups have disproportionately high COVID-19 vaccine hesitancy and lower vaccine uptake.

OBJECTIVE

To determine whether provision of COVID-19 vaccine messaging platforms in EDs increases COVID-19 vaccine acceptance and uptake in unvaccinated patients.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cluster randomized clinical trial was conducted at 7 hospital EDs in 4 US cities from December 6, 2021, to July 28, 2022. Noncritically ill adult patients who had not previously received COVID-19 vaccines were enrolled.

INTERVENTIONS

A 3-pronged COVID-19 vaccine messaging platform (an English- or Spanish-language 4-minute video; a 1-page informational flyer; and a brief, scripted message from an ED physician or nurse) was delivered during patient waiting times.

MAIN OUTCOMES AND MEASURES

The 2 primary outcomes were (1) COVID-19 vaccine acceptance, assessed by survey responses in the ED, and (2) receipt of a COVID-19 vaccine within 30 days, ascertained by ED confirmation of vaccination, electronic health record review, and telephone follow-up.

RESULTS

Of the 496 participants enrolled (221 during intervention weeks and 275 during control weeks), the median (IQR) age was 39 (30-54) years, 205 (41.3%) were female, 193 (38.9%) were African American, 97 (19.6%) were Latinx, and 218 (44.0%) lacked primary care physicians. More intervention group participants, compared with control participants, stated that they would accept the vaccine in the ED (57 [25.8%] vs 33 [12.0%]; adjusted difference, 11.9 [95% CI, 4.5-19.3] percentage points; number needed to treat [NNT], 8 [95% CI, 5-22]). More intervention group participants than control participants received a COVID-19 vaccine within 30 days of their ED visit (44 [20.0%] vs 24 [8.7%]; adjusted difference, 7.9 [95% CI, 1.7-14.1] percentage points; NNT, 13 [95% CI, 7-60]). The intervention group had greater outcome effect sizes than the control group in participants who lacked a primary care physician (acceptance, 38 of 101 [37.6%] vs 16 of 117 [13.7%] [P for interaction = .004]; uptake, 31 of 101 [30.7%] vs 11 of 117 [9.4%] [P for interaction = .006]), as well as in Latinx persons (acceptance, 23 of 52 [44.2%] vs 5 of 48 [10.4%] [P for interaction = .004]; uptake, 22 of 52 [42.3%] vs 4 of 48 [8.3%] [P for interaction < .001]).

CONCLUSIONS AND RELEVANCE

Results of this cluster randomized clinical trial showed that with low NNT, implementation of COVID-19 vaccine messaging platforms in EDs leads to greater vaccine acceptance and uptake in unvaccinated ED patients. Broad implementation in EDs could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05142332.

Extracellular inflammasomes as novel endogenous danger signals that exert pro-inflammatory signaling on vascular cells

Background and aims

As part of the innate immune response, NLRP3 inflammasomes are involved in the process of sterile inflammation, IL-1β release and are key mediators of inflammation-related vascular diseases, such as atherosclerosis. Recent data showed the existence of extracellular inflammasomes released from monocytes during pyroptotic cell death. Their biological function in the vascular system is still not known. Here, we established a method to detect extracellular inflammasomes and tested the hypothesis that extracellular NLRP3 inflammasomes can be internalized by vascular cells, such as macrophages, endothelial cells and coronary smooth muscle cells and induce pro-inflammatory signaling.

Methods and result

Stimulation of THP1 monocytes and of isolated primary human monocytes with Lipopolysaccharide and Nigericin activated the NLRP3 inflammasome and induced pyroptosis and the release of inflammasome complexes. Extracellular inflammasomes were isolated from cell-free supernatant and identified as inflammasome complexes (oligomers) by immunoblot. For functional characterization, isolated fluorescent-labeled NLRP3 inflammasome complexes were shown to be internalized by THP1 macrophages (19.7±9.7% pos. cells), primary endothelial cells (HUVEC: 9.0±2.3% pos. cells, coronary artery endothelial cells: 11.0% ± 2.3% pos. cells) and coronary smooth muscle cells (42.8±9.9% pos.cells) using immunofluorescence staining, Z-stacks and imaging flow cytometric analysis. Extracellular NLRP3 inflammasomes (eNLRP3) induced pro-inflammatory signaling in macrophages by increasing IL1b and Tnfa gene expression (3.0- fold) as well as IL-1β release (con: 1.9 pg/ml vs. eNLRP3: 191.0 pg/ml). In coronary smooth muscle cells, treatment with extracellular inflammasomes increased endogenous Nlrp3 and IL1b gene expression as well as upregulation of Cell adhesion molecule 1 (Cadm1). Coronary artery endothelial cells showed also increased protein level of surface adhesion marker Intercellular Adhesion Molecule 1 (ICAM1).

Conclusion

Upon canonical NLRP3 inflammasome activation, mononuclear cells release inflammasome complexes into the extracellular space. Macrophages, endothelial cells and smooth muscle cells are able to internalize these extracellular inflammasome complexes that exert pro-inflammatory effects. These findings support the concept that cell-free NLRP3 inflammasomes act as extracellular signal molecules triggering pro-atherogenic signaling mechanisms in vascular cells.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Leipzig University, Medical Faculty

Tumor model for laparoscopy in pediatric oncology: subperitoneal inoculation of human hepatoblastoma cells in nude rats

BACKGROUND

Minimally invasive surgery (MIS) for diagnostic or even ablative purposes in pediatric oncology is gradually evolving, but little is known about its biological consequences and surgical complications. Especially for hepatoblastoma (HB), no study on the influence of laparoscopy is available yet. A special tumor model could facilitate a variety of investigations. The present study introduces a laparoscopic technique to create subperitoneal metastases of human HB.

METHODS

7 immuno-incompetent (rnu/rnu) rats (mean weight 198 g) received a stab incision in the lower abdomen to insert a 4 mm scope. Under laparoscopic guidance (CO2 pressure of 1 mmHg, flow of 0.2 l/min) an 18 G needle was introduced, to inject several subperitoneal deposits of the tumor cell suspension (HuH6, 3 x 10 (6) in 1 ml of RPMI-1640 medium). Tumor growth was allowed for 6 - 7 weeks and finally the animals were laparoscopically evaluated for peritoneal metastases. Each suspicious lesion was harvested for histology.

RESULTS

One animal was investigated after 6 weeks without evidence of tumor growth. After 7 weeks, in 4 out of 6 animals at least one lesion could be detected. Histology revealed HB in all specimens.

CONCLUSION

Subperitoneal inoculation of human HB cells in nude rats achieves intraabdominal tumor growth. The present model allows a variety of laparoscopic strategies and their oncological impact to be studied. Thus it may contribute to the development of distinct oncological concepts for MIS in children with HB.

Videoscopic fluorescence diagnosis of peritoneal and thoracic metastases from human hepatoblastoma in nude rats

BACKGROUND

Various medical disciplines are employing photodynamic diagnosis (PDD) when searching for malignancies. It is still unknown whether pediatric solid tumors such as hepatoblastoma are susceptible to this technique as well.

METHODS

Human hepatoblastoma cells were injected into the abdomen or right thoracic cavity of nude rats. Tumor growth was allowed for 7 weeks. Then, photosensitization was induced by peritoneal lavage with 5-aminolevulinic acid (ALA). Applying the Storz PDD system and one 4-mm scope, all animals were investigated by videoscopic white light diagnosis (WD) and PDD. Suspicious lesions were marked and analyzed by spectrometry and histology.

RESULTS

Positive fluorescence was documented for every tumor seen by WD in the abdomen or right thoracic cavity. Spectrometry of lesions showed a 6.34-fold increased fluorescence intensity. Histology revealed hepatoblastoma in all specimens.

CONCLUSIONS

Human hepatoblastoma can be detected by PDD in a rat model. Considering the clinical success of this method in other specialties, our findings indicate that further investigations to evaluate the benefit of PDD for children with hepatoblastoma should be performed.

The distribution of copper in sickling erythrocytes as determined by an IBM cell separator

Elevated levels of copper have been found in sickling erythrocytes. Since this copper may inhibit sickling or induce hemolysis the authors decided to investigate the distribution of copper in sickling erythrocytes to gain some insight into its origin. When samples of sickling erythrocytes were fractionated by density gradient centrifugation with an IBM cell separator and the fractions analyzed for copper, it was found that the copper to hemoglobin ratio of the different fractions varied several fold. This finding indicated that the copper in sickling erythrocytes did not equilibrate with the copper in serum or other cells and that the copper was present in the cells when they were released into the blood stream. When erythrocytes were obtained from a sickle cell patient four days post-crises, a large amount of residual copper could be observed in the first (youngest) fraction. It was suspected that this copper was in mitochondrial residues. It was also observed that copper levels tended to be higher in control and sicklings erythrocytes during the winter months. The predominance of the first fraction in samples of sickling erythrocytes taken during the winter months suggests that the turnover of sickling erythrocytes is accelerated at this time.