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PubMed1982

Stability of diazepam injection repackaged in glass unit-dose syringes.

The stability of diazepam injection repackaged in disposable glass syringes and stored at room and refrigerator temperatures was studied. Thirty-nine 1.5-ml syringes were filled with 1.1 ml diazepam injection 5-mg/ml. All syringes were stored in light-resistant bags on their sides so that the solution was in contact with the rubber stoppers on both ends. Samples were assayed with a stability-indicating HPLC method for diazepam and its degradation product, 2-methylamino-5-chloro-benzophenone (MACB), after 30, 60, and 90 days of storage at 30 degrees C and 4 degrees C. At 90 days, the diazepam injection stored at 4 degrees C retained 97.4 +/- 1.6% of its original potency; samples stored at 30 degrees C retained 92.4 +/- 1% of their original potency. Apparent sorption to rubber syringe components led to a decrease in the concentration of both diazepam and MACB. The decrease in diazepam was a function of storage time and temperature; however, the disappearance of MACB from the syringes was a function of only time. Diazepam injection is chemically stable as 5-mg doses in disposable glass syringes for 90 days when stored at 4 degrees C or 30 degrees C. However, refrigeration is recommended.

Diazepam↗
PubMed1981

Stability of diluted heparin sodium stored in plastic syringes.

The stability of heparin diluted in 0.9% sodium chloride injection and stored in plastic syringes for a three-week period was studied. Heparin activity was assayed by the activated partial thromboplastin time (APTT) method. Heparin sodium (25,000 units/ml) was diluted to 500 units/ml and stored in 50-ml polypropylene syringes. Concentrations were compared in two brands of syringes stored at room temperature in the dark. In another experiment controlled for order-related assay errors, heparin was stored in one brand by syringe at either 0-4 degrees C or room temperature. There was a statistically decrease in heparin activity over three weeks in both syringes and at both 0-4 degrees C and room temperature. However, the overall drop in activity was only about 8%. Analysis of covariance confirmed significant regression with time at both temperatures. An unexpected finding was that heparin at 500 units/ml consistently assayed higher than this value. A study of the effect of glass and plastic showed that when heparin was diluted into either a glass or plastic container, there was significantly less heparin activity in the glass containers within two hours. One possible explantation for this phenomenon is absorption of heparin to glass surfaces. It was concluded that heparin can be stored in polypropylene syringe for up to three weeks without refrigeration. However, once diluted, heparin should not be stored in glass containers.

Drug Packaging↗
PubMed1993

Stability of octreotide acetate in polypropylene syringes.

The stability of octreotide acetate in polypropylene syringes was studied. Polypropylene syringes were aseptically filled with 1 mL of octreotide acetate 0.2 mg/mL and stored at 3 or 23 degrees C under light protection or light exposure. Three syringes were prepared for each condition and each sampling time. Unopened 5-mL glass vials of the drug served as controls. Samples were removed immediately and at 8, 15, 22, and 29 days and analyzed by high-performance liquid chromatography. At 3 degrees C, octreotide stored in light-protected syringes maintained more than 90% of its initial concentration for up to 29 days. However, at 22 days the concentration in the syringes stored at that temperature and exposed to light was less than 90% when the standard deviation is considered. At 23 degrees C, the drug was stable for only up to 15 days (light protection) and 22 days (light exposure) when the standard deviation is considered. Octreotide acetate in polypropylene syringes was stable for up to 29 days when stored at 3 degrees C and protected from light and for up to 22 days when stored at 23 degrees C and exposed to light.

Chemistry, Pharmaceutical↗
PubMed1997

Evaluation of the role of syringing prior to cataract surgery.

Patients for cataract surgery in India routinely undergo preoperative syringing to rule out chronic dacryocystitis. We determined the sensitivity and specificity of the clinical test of regurgitation on pressure over the lacrimal sac (ROPLAS) as a screening test for chronic dacryocystitis and compared it to syringing. 621 consecutive outpatients who needed syringing for various reasons (including 318 who had routine syringing prior to cataract surgery) were examined in a masked manner for regurgitation on pressure over the lacrimal sac. They then underwent syringing by a trained (masked) observer. The sensitivity and specificity of ROPLAS were 93.2% and 99.3%, respectively. Using a 6.6% prevalence of chronic dacryocystitis (the prevalence in our cataract population), the negative predictive value of the test was 99.5%. In the presence of regurgitation of pressure over the sac, the high specificity of ROPLAS confirms chronic dacryocystitis. In view of the opportunity costs, when ROPLAS is negative, preoperative syringing in cataract is perhaps unnecessary, unless the findings are equivocal or the index of suspicion for chronic dacryocystitis is very high.

Cataract↗
PubMed1987

Retention and variability of hydrogen (H2) samples stored in plastic syringes.

The utility of two brands of 20 ml plastic syringes for storage of hydrogen (H2) samples as obtained in H2 breath tests were studied. Plastipak syringes were found to be significantly better with regard to the stability of the H2 concentration and the variability between the H2 samples. Storage of the H2 samples in Plastipak syringes at 5 degrees C significantly improved the H2 retention, whereas refrigeration of H2 samples stored in Once syringes did not reduce H2 loss. Storage of H2 samples in refrigerated plastic syringes is efficient and reliable for several days if syringes with minimal sample variation are used.

Breath Tests↗
PubMed1998

The validation of statements by IDUs based on the analysis of blood traces on their used syringes.

The objective of this study was to study the correlation between statements made by injecting drug users (IDUs) and the analytical observation of their used syringes, with regard to needle and syringe non-sharing and HIV serology. A survey was carried out on 137 IDUs participating in different needle exchange programmes (NEPs) throughout the Basque Autonomous Community (BAC). The used syringe they handed over in exchange for a new one was kept to study the 'DNA fingerprint' and the presence of HIV. The DNA fingerprint carried on 123 syringes belonging to different injectors who stated that they had not shared them with other IDUs, confirmed that this was so in 98% of the cases. HIV analysis was applied to the 137 syringes and 63 (46%) had HIV antibodies. The consistency was 89% for the cases who voluntarily declared themselves to be HIV-positive and 76% for the cases who declared themselves to be HIV-negative. For the unknown cases, six (31.6%) syringes were HIV-positive. This study supports the validity and reliability of the surveys, based on statements made by the IDUs themselves, on their behaviour. The prevalence of HIV infection in the IDU population must be based on detection of antibodies against HIV.

Cross-Sectional Studies↗
PubMed2006

Needle syringe acquisition and HIV prevention among injecting drug users: a treatise on the "good" and "not so good" public health practices in South Asia.

This article describes the prevalence of HIV/AIDS and other bloodborne infections is well established among injection drug user (IDU) populations in South Asia (SA). IDU populations in SA are diverse and display different demographic and socioeconomic profiles. The current provision of sterile injecting equipment as part of public health initiatives is suboptimal. Although some needle and syringe exchange programs (NSEPs) operate in the region, pharmacies and "friends" continue to be a major source of syringe acquisition. It is suggested that the cost of syringes in the region is significantly higher in real terms than in several other countries and negatively impacts on the ability of IDUs to acquire needles and syringes. In addition, existing NSEPs offer poor coverage both at the population and individual level. Their effective functioning is hampered by resource constraints, ambivalent policy positions, little attention to quality, and environmental factors. Secondary syringe exchange is a nascent phenomenon in SA that needs to be adequately documented and evaluated. Urgent attention needs to be given to developing alternative models of needle syringe delivery to scale-up HIV prevention interventions for IDUs. This study was conducted in the first quarter of 2004 and updated in 2006. We used key informants, previously unpublished and published data from research studies, and interventions programs, service statistics, and primary data to inform this study.

Asia↗
PubMed2001

Social factors related to syringe sharing among injecting partners: a focus on gender.

The study of social networks has become an increasingly utilized method of examining the relationship between injection drug users' social environment and risk of HIV. This study examined relational aspects of two injection drug users (IDUs) within a single social network as they relate to sharing syringes. Data presented in this study were derived from baseline interviews of 508 IDUs from Baltimore, MD. Analyses were performed separately for male and female participants in an effort to understand gender differences in social aspects of syringe sharing. Among this sample, women shared syringes with a significantly higher percentage of injecting partners compared to men. In separate multilevel logistic regression models, significant variables associated with males' and females' syringe sharing were: sharing drugs daily with female injecting partners, injecting partners' provision of drugs when indexes' were withdrawing, being sexual partners, and injecting partners' injecting speedballs. Factors associated with male injecting dyads sharing of syringes were: being kin, injecting partners' injection of heroin and daily drug use, and drinking alcohol together. Results from this study demonstrate the usefulness of examining relationship characteristics of injecting dyads related to syringe sharing as they differ between men and women.

Acquired Immunodeficiency Syndrome↗
PubMed2007

Modelling the impact on Hepatitis C transmission of reducing syringe sharing: London case study.

BACKGROUND: Hepatitis C virus (HCV) prevalence and incidence among injecting drug users (IDUs) has increased in London and rest of UK. To inform public health action, mathematical modelling is used to explore the possible impact of strategies to decrease syringe sharing. METHODS: A mathematical model was developed to simulate HCV transmission amongst IDUs in London. Because of parameter uncertainty, numerical search algorithms were used to obtain different model fits to HCV seroprevalence data from London for 2002-03. These simulations were used to explore the likely impact of HCV prevention activities that reduce syringe sharing amongst all IDUs, IDUs that have injected for greater than one year, or IDUs with lower or higher frequencies of syringe sharing. RESULTS: Key differences between model fits centred on how they simulated the high HCV incidence amongst new injectors, either through assuming increased HCV infectivity during acute infection, a large sub-group of high frequency syringe sharers, or increased sharing among new IDUs. Despite parameter uncertainty, the model projections suggest that modest reductions in syringe sharing frequency (<25%) will reduce the HCV seroprevalence in newly initiated IDUs (injecting less than four years) but much larger and sustained reductions (>50%) are required to reduce the HCV seroprevalence in long-term IDUs (injecting more than 8 years). Critically the model also suggested that large reductions in HCV seroprevalence will be achieved only if interventions target all IDUs and reach IDUs within 12 months of injecting. DISCUSSION: Public health interventions must reduce syringe sharing amongst all IDUs, including newly initiated IDUs, and be sustained for many years to reduce HCV infection. More accurate data on key behavioural (sharing frequency) and biological (percentage of infected IDUs that clear infection) parameters is required to improve model projections.

Female↗
PubMed1993

Evaluation of syringe-exchange for HIV prevention among injecting drug users in rural and urban areas of Wales.

This paper considers the prevention of HIV in rural and urban areas among both opiate and non-opiate drug injectors. A 2-year study evaluated specialist and community based syringe-exchange provision in Wales. Numbers of clients and patterns of attendance at eight syringe-exchange schemes were monitored together with comparative cross-sectional studies of attenders (n = 152) and non-attenders (n = 176) from the population of drug injectors in 1990 and 1991. A total of 1171 clients made 7553 visits in the 2-year period, 110,000 syringes were issued and 80% of needles and syringes were returned. There were few demographic differences between attenders and non-attenders, but large and significant differences in HIV risk behaviour; only 9% of attenders had recently shared syringes in 1990 (10% in 1991) compared to 41% of non-attenders (39% in 1991). The catchment areas of specialised services were limited (5 miles or less) and insufficient in rural areas. Alternative community approaches to syringe distribution and exchange are examined.

Cross-Sectional Studies↗
PubMed1984

Cements containing syringic acid esters -- o-ethoxybenzoic acid and zinc oxide.

Fissure caries is reduced when syringic acid is incorporated into a cariogenic diet of rats. It was therefore of interest to synthesize n-hexyl and 2-ethylhexyl syringate and to evaluate the properties of cements with these compounds as ingredients. Liquids containing the esters dissolved in o-ethoxybenzoic acid (EBA) - when mixed with powders made up from zinc oxide, aluminum oxide, and hydrogenated rosin - hardened in from four to nine min. Properties of the cements were determined, when possible, according to ANSI/ADA specification tests. Depending on the powder-liquid ratio employed, we obtained compositions with varying physical properties desirable for different dental applications. The syringate cements, compared with the commonly used ZOE materials, have improved compressive and tensile strength, lower water solubility, do not inhibit polymerization, and are compatible with acrylic monomers. These cements pass, and mostly greatly exceed, the requirements for ZOE-type restorative materials. They also bond significantly to resins, composites, and non-precious metals. The bond strength is somewhat less than that of n-hexyl vanillate-EBA cement, but greatly exceeds the adhesion to various substrates of ZOE luting agents. Cements containing n-hexyl syringate were somewhat brittle. Best results were obtained with liquid compositions containing 5% 2-ethylhexyl syringate, 7% n-hexyl vanillate, and 88% EBA, which yielded non-brittle materials. These cements, because of the syringate ingredient, may possess caries-reducing properties. Thus, perhaps in conjunction with fluoride additives, they would be useful as insulating bases, pulp capping agents, root canal sealers, soft tissue packs, or intermediate restoratives.

Chemical Phenomena↗
PubMedDate not supplied

Recent incarceration independently associated with syringe sharing by injection drug users.

OBJECTIVES: Few prospective studies are available on the relationship between incarceration and HIV risk among injection drug users (IDUs). The authors evaluated self-reported rates of syringe sharing and incarceration among a cohort of IDUs. METHODS: This study analyzed syringe lending by HIV-infected IDUs and syringe borrowing by HIV-negative IDUs among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available, variables potentially associated with each outcome (syringe lending and borrowing) were evaluated using generalized estimating equations for binary outcomes. RESULTS: The study sample consisted of 1,475 IDUs who were enrolled into the VIDUS cohort from May 1996 through May 2002. At baseline, 1,123 (76%) reported a history of incarceration since they first began injecting drugs. Of these individuals, 351 (31%) reported at baseline that they had injected drugs while incarcerated. Among 318 baseline HIV-infected IDUs, having been incarcerated in the six months prior to each interview remained independently associated with syringe lending during the same period (adjusted odds ratio [OR]=1.33; 95% confidence interval [CI] 1.06, 1.69; p=0.015). Similarly, among the 1,157 baseline HIV-negative IDUs, having been incarcerated in the six months prior to each interview remained independently associated with reporting syringe borrowing during the same period (adjusted OR=1.26; 95% CI 1.12, 1.44; p<0.001). CONCLUSIONS: Incarceration was independently associated with risky needle sharing for HIV-infected and HIV-negative IDUs. This evidence of HIV risk behavior should reinforce public health concerns about the high rates of incarceration among IDUs.

Adult↗
PubMed1994

Syringe pumps for infusion of vasoactive drugs: mechanical idiosyncrasies and recommended operating procedures.

Syringe pumps for vasoactive infusions have the advantages of small size and weight, portability, and low cost of the disposable components. However, limited syringe capacity necessitates the use of high drug concentrations, and the accidental delivery of even a small volume of infusate could seriously alter the patient's hemodynamics. To determine the circumstances under which drug delivery might be delayed, or inadvertent boluses could be delivered into the manifold, two brands of commercially available clinical syringe pumps were connected to a stopcock manifold via small-bore tubing and a series of tests were performed. When the syringe pumps were operated at 3 mL/h against a closed stopcock, the pumps' occlusion alarms did not sound for 18-22 min, and when the stopcock subsequently was opened, 0.6-0.9 mL of infusate was delivered as a bolus. Elevating the syringe pump by 120 cm resulted in the delivery of up to 0.5 mL of infusate with the pump turned off. When a syringe pump operating at 6 mL/h was turned off, typically an additional 0.05 mL was delivered during the ensuing 2-3 min. Depending upon the method used to flush the tubing prior to use, delays in drug delivery of 2-3 min occurred at an infusion rate of 3 mL/h. These observations emphasize the need for careful equipment setup and proper use of the manifold stopcocks to avoid unintended drug administration or delay in drug administration.

Infusion Pumps↗
PubMed1996

The legal strategies used in operating syringe exchange programs in the United States.

OBJECTIVES: This study sought to identify the strategies used by syringe exchange programs to establish their legality. METHODS: Statutes, court decisions, published studies of exchange programs, and news stories were reviewed, and telephone interviews were conducted with syringe exchange personnel. RESULTS: Twenty-seven exchanges have been authorized by amendments to or judicial interpretations of state drug laws or by administrative action under such laws, or operate in a state that has no laws regulating needles. At least 13 programs operate under claims of legality based on local interpretations of state law, principally public health law. The remaining syringe exchanges operate without a claim of legality. CONCLUSIONS: The deployment of syringe exchanges has been hindered by concerns about their legal status. This study shows that the applicability of drug laws to syringe exchange is open to dispute, and that local public health authorities may under some circumstances rely on their own legal authority to fund or operate syringe exchange programs.

Drug Prescriptions↗
PubMed1995

Syringe exchange: HIV prevention, key findings, and future directions.

HIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to "condone" an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors.

Cross-Sectional Studies↗
PubMed1988

[Morphine self-administration by rats using a pneumatic syringe].

An apparatus for drug self-administration by rats using a pneumatic syringe was developed by Weeks. A microliter syringe operated by a pneumatic cylinder supplies an accurate volume of drug solution within one second. When coefficient of variation of infusion volume was compared among pneumatic syringe, infusion pump, and peristaltic pump, pneumatic syringe showed higher accuracy in infusion volume than the other two pumps. Since the infusion speed by a pneumatic syringe is very rapid (less than one second per infusion), the effect of infusion speed on reinforcing property of morphine was investigated. When rats self-administered 0.1, 0.3, 1.0, and 3.0 mg/kg/infusion of morphine by pneumatic syringes, the patterns of self-infusion were more stable, the number of self-infusions and the amount self-administered were larger, and a dose-response relationship was clearer in comparison with those self-infused the same doses of morphine for 5.6 seconds by infusion pumps or peristaltic pumps.

Animals↗
PubMed1994

Estimating the number of HIV transmissions through reused syringes and needles in the Mbeya Region, Tanzania.

OBJECTIVE: HIV infection attributable to medical injections is suspected to be low, although case-control studies have not provided definite results. This study aims to determine the number of HIV infections caused by the reuse of syringes and needles in the Mbeya Region, Tanzania. METHODS: The direct identification or detection of HIV in syringes and needles under field conditions was not appropriate, therefore a surrogate marker consisting of two components for possible HIV transmission was used: insufficient sterilization, and blood remaining from a previous patient. The assumption was that HIV infection can only occur if both markers are positive. Samples were collected in nine health-care facilities. All syringes and needles prepared for use in these facilities were collected without prior notification. The samples were rinsed and the resulting fluid was cultured for bacteria. Traces of blood were detected by urine stick test for haemoglobin volumes > 0.0015 microliters. RESULTS: Bacterial contamination was found in 32.8% of the total 1219 syringes and needles; 67% was caused by improper handling of the equipment after sterilization. Blood was detected in 12.5% of the samples. In the following three sampling strata, both contamination criteria were positive either on the syringe or the needle: wards/outpatient departments (OPD), 1.39%; laboratories, 7.45%; expanded programme on immunization (EPI), < 0.1%. We calculated that from 1.1 million patients injected in wards/OPD in any 1 year, fewer than 13 become infected, in laboratories fewer than 12 (160,000 blood-taking procedures), and less than one child in the EPI (850,000 vaccinations). CONCLUSION: With an established AIDS intervention programme supporting the health system, less than 0.4% of the total annual incidence of 4500-8500 is attributable to medical injections in the Mbeya Region.

Case-Control Studies↗
PubMed1999

Sterilizable syringes: excessive risk or cost-effective option?

In recent years, many poorer countries have chosen to use disposable instead of sterilizable syringes. Unfortunately, the infrastructure and management systems that are vital if disposables are to be used safely do not exist. WHO estimates that up to 30% of injections administered are unsafe. The traditional sterilizable syringe had many disadvantages, some of which have been minimized through better design and the use of modern materials; others have been overcome because staff are able to demonstrate that they have performed safely. For example, the time-steam saturation-temperature (TST) indicator has enabled staff to demonstrate that a sterilizing cycle has been successfully completed. Health facility staff must be able to sterilize equipment, and the sterilizable syringe remains the least costly means of administering an injection. Data from countries that have acceptable systems for processing clinical waste indicate that safe and environmentally acceptable disposal, destruction and final containment cost nearly as much as the original cost of a disposable syringe. By careful supervision of staff behaviour and good management, some countries have demonstrated that they are able to administer safe injections with sterilizable syringes at a price they can afford.

Cost-Benefit Analysis↗