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Aquagenic syringeal acrokeratoderma: report of a case with histologic findings.

Aquagenic syringeal acrokeratoderma is a rare acquired condition characterized by painful symmetric swelling and hypopigmentation of the palms and lateral fingers, which develops after brief exposure to water. Histopathologic examination suggests that an aberration in the eccrine sweat gland apparatus may be the underlying cause of this condition. The "hand-in-the-bucket sign," in which patients arrive in their physician's office with their hand in a bucket of water to more readily demonstrate their lesions, is such a common presentation that it almost can be regarded as pathognomonic. All 12 cases reported to date have been in young females. We report a case of aquagenic syringeal acrokeratoderma in a male with unique histologic findings.

Adult↗

New trends in sample preparation: on-line microextraction in packed syringe (MEPS) for LC and GC applications Part III: Determination and validation of local anaesthetics in human plasma samples using a cation-exchange sorbent, and MEPS-LC-MS-MS.

The need for on-line sample preparation for high-throughput applications in bioanalysis has increased during the past decade. In this paper a robust and on-line sample preparation technique, micro extraction in packed syringe (MEPS) has been developed and validated. The method is a miniaturized, fully automated, solid-phase extraction (SPE) technique that can be connected on-line to GC or LC without any modification of the chromatographs. The performance of MEPS as sample preparation method is illustrated by the determination of local anaesthetics in human plasma samples on-line with high performance liquid chromatography (HPLC) and tandem mass spectrometry. The sampling sorbent was 1mg silica based benzenesulphonic acid cation exchanger that was inserted in a 250 microl syringe. Ropicavine and two of its metabolites (PPX and 3-OH-ropivacine), lidocaine and bupivacine were used as model substances. The accuracy values of quality control samples (QC) were between 95% and 109%, and precision (relative standard deviation, R.S.D.) had a maximum deviation of 9% for the analytes.

Anesthetics↗

Ownership, availability, and use of portable syringe drivers among hospices and home-care services.

We ascertained the ownership, availability and extent of use of portable syringe drivers among 236 hospice in-patient units and home-care services for the terminally ill in the United Kingdom by means of a postal questionnaire (97% response rate). Only 11 hospices and home-care services did not use them. The rest owned a median number of 4 but had only 1 in use. However, the combined hospice with home-care services owned relatively more than either hospices or home-care teams (median number 6 compared to 3.5 and 4 respectively) and used relatively more than the others (estimated median 2 [95% CI: 1-2] compared to 1 [95% CI: 0-1] and 1 [95% CI: 1-2] respectively). The major determinants of ownership and use among units with an in-patient facility were supply factors such as the numbers of trained nurses in palliative care and doctor half-day sessions, whereas for home-care units the number of patients cared for daily was the most important determinant. There does not seem to be any unmet demand for portable syringe drivers among hospices and home-care services.

Home Care Services↗

Randomised controlled trial of combined diphtheria, tetanus, whole-cell pertussis vaccine administered in the same syringe and separately with Haemophilus influenzae type b vaccine at two, three and four months of age.

An open randomised controlled multicentre study compared the immunogenicity and reactogenicity of three vaccines given by injection at two, three and four months of age. Children (89) received Haemophilus influenzae type b (Hib) vaccine (SmithKline Beecham Biologicals [SB]) administered in the same syringe with combined diphtheria-tetanus-whole-cell pertussis (DTPw) vaccine (Evans); 75 received Hib vaccine (SB) administered as a separate injection with DTPw vaccine; 66 received Hib vaccine (Pasteur Merieux [PM]) administered as a separate injection with DTPw vaccine. All subjects in both groups receiving Hib (SB) vaccine had levels of antibodies to the Hib polysaccharide polyribosylribitol phosphate (PRP) greater than 0.15 microgram ml-1 as did 97% of those receiving Hib (PM) vaccine 1 month after administration of the final vaccine dose. Subjects in all three groups demonstrated an immunological response to pertussis, diphtheria and tetanus antigens. The geometric mean titres of the group given Hib (SB) and DTPw vaccine mixed in the same syringe were lower than the other groups. There were no apparent differences between the treatment groups in the incidence of local or systemic reactions, or serious adverse events. This study has confirmed that it is possible to halve the number of injections necessary to offer protection, with advantages to parents, children, doctors and nurses, using a combined DTPwHib vaccine and in accordance with the UK's accelerated primary immunisation schedule at two, three and four months of age.

Antibodies↗

Nonisothermal bioreactors in the treatment of vegetation waters from olive oil: laccase versus syringic acid as bioremediation model.

Laccase from Trametes versicolor was immobilized by diazotization on a nylon membrane grafted with glycidil methacrylate, using phenylenediamine as spacer and coupling agent. The behavior of these enzyme derivatives was studied under isothermal and nonisothermal conditions by using syringic acid as substrate, in view of the employment of these membranes in processes of detoxification of vegetation waters from olive oil mills. The pH and temperature dependence of catalytic activity under isothermal conditions has shown that these membranes can be usefully employed under extreme pH and temperatures. When employed under nonisothermal conditions, the membranes exhibited an increase of catalytic activity linearly proportional to the applied transmembrane temperature difference. Percentage activity increases ranging from 62% to 18% were found in the range of syringic acid concentration from 0.02 to 0.8 mM, when a difference of 1 degrees C was applied across the catalytic membrane. Because the percentage activity increase is strictly related to the reduction of the production times, the technology of nonisothermal bioreactors has been demonstrated to be an useful tool also in the treatment of vegetation waters from olive oil mills.

Agriculture↗

Simultaneous phase- and size-controlled synthesis of TiO(2) nanorods via non-hydrolytic sol-gel reaction of syringe pump delivered precursors.

The simultaneous phase- and size-controlled synthesis of TiO(2) nanorods was achieved via the non-hydrolytic sol-gel reaction of continuously delivered two titanium precursors using two separate syringe pumps. As the injection rate was decreased, the length of the TiO(2) nanorods was increased and their crystalline phase was simultaneously transformed from anatase to rutile. When the reaction was performed by injecting titanium precursors contained in two separate syringes into a hot oleylamine surfactant solution with an injection rate of 30 mL/h, anatase TiO(2) nanorods with dimensions of 6 nm (thickness) x 50 nm (length) were produced. When the injection rate was decreased to 2.5 mL/h, star-shaped rutile TiO(2) nanorods with dimensions of 25 nm x 200 nm and a small fraction of rod-shaped anatase TiO(2) nanorods with dimensions of 9 nm x 100 nm were synthesized. Pure star-shaped rutile TiO(2) nanorods with dimensions of 25 nm x 450 nm were synthesized when the injection rate was further decreased to 1.25 mL/h. The simultaneous phase transformation and length elongation of the TiO(2) nanorods were achieved. Under optimized reaction conditions, as much as 3.5 g of TiO(2) nanorods were produced. The TiO(2) nanorods were used to produce dye-sensitized solar cells, and the photoconversion efficiency of the mixture composed of star-shaped rutile TiO(2) nanorods and a small fraction of anatase nanorods were comparable to that of Degussa P-25.

Crystallization↗

A robust multi-syringe system for process flow analysis. Part 3. Time based injection applied to the spectrophotometric determination of nickel(II) and iron speciation.

A new software-controlled time-based system for sample or reagent introduction in process flow injection analysis was developed. By using a multi-syringe burette coupled with one multi-port selection valve, the time-based injection of precise known volumes was accomplished. Characteristics and performance of the injection system were studied by injecting an indicator in a buffered carrier. Two multi-syringe time-based injection (MS-TBI) systems were implemented: first, the injection of a sample in a multiple-channel manifold where the sample would sequentially merge and react with different reagents, and second, the sequential injection of several solutions (sample and reagents) into a particular flowing stream. The first system was applied to the spectrophotometric determination of nickel(II) in diluted samples from the acidic nickel ore leaching process, by using ammonium citrate as carrier, a saturated solution of iodine as oxidizing agent and alkaline dimethylglyoxime as chromogenic reagent. The sampling frequency attained was 57 h-1. Determinations on process samples compared well at the 95% confidence level with the reference values obtained by ICP-OES. The second time-based injection system was applied to the speciation of iron. Total iron and iron(II) concentrations were separately and sequentially determined using 1,10-phenanthroline in acetic buffer medium as reagent. The developed manifold allowed the optional use of two different carrier solutions, containing or not containing ascorbic acid, for performing the separate determinations. Also, in the sequential procedure, plugs of reducing carrier were alternatively intercalated before the sample injections used for total iron determinations. Sampling frequencies of 68 injections per hour were routinely used. Accuracy was assessed by analyzing synthetic known mixtures of Fe(III) and Fe(II) standard solutions. Recoveries of 98-100.5% with a maximum relative standard deviation of 3.6% were found. Results obtained for various samples of fertilizers agreed well with those attained by the standard batch procedure.

Journal Article↗

Liposuction of neck and jowls: five-incision method combining machine-assisted and syringe aspiration.

BACKGROUND: Liposuction of the jowl region is difficult from a single submental incision and must be done conservatively in order to avoid overresection of fat. The neck region may be suctioned much more completely. OBJECTIVE: A new method for liposuction of the neck and jowls that uses five incisions and that combines syringe suctioning of the jowls and machine-assisted suctioning of the neck has been developed. METHODS: The neck was suctioned from submental and infra-auricular incisions. The jowls were suctioned from the infra-auricular and additional infrajowl incisions. RESULTS: This method has been used on 68 patients over a 3-year period. Three additional patients underwent syringe liposuction of only the jowls. Volumes of fat aspirated from bilateral jowls were consistently nearly equal. The incidence of adverse events was low. CONCLUSION: This method enables conservative removal of jowl fat and thorough removal of neck fat, with a low incidence of adverse sequalae.

Cheek↗

Lavage technique in total hip arthroplasty: jet lavage produces better cement penetration than syringe lavage in the proximal femur.

Sixteen paired human cadaver femora were prepared using conventional broaches. Cancellous bone was irrigated with 1 L pulsed lavage in one femur and 1 L syringe lavage in the contralateral femur. The specimens were embedded in specially designed pots, and vacuum-mixed bone-cements were applied in a retrograde manner. After application of a standard pressure to the pots, the femora were removed and radiographed, and horizontal sections were obtained and analyzed to assess cement penetration into cancellous bone and the ratio of the area of supported to unsupported cancellous bone (Rcb). Our results show that in equal quality bone, the use of jet lavage yields significantly (P < .0001) improved cement penetration and Rcb compared with syringe lavage specimens. Jet lavage should be considered routine to achieve interdigitation with cancellous bone in cemented total hip arthroplasty.

Arthroplasty, Replacement, Hip↗

HIV risk behaviours of current sex workers attending syringe exchange: the experiences of women in five US cities.

Existing research indicates that sex workers who inject drugs are vulnerable to HIV infection through both risky sexual and drug use practices. This study is the first attempt to learn whether this increased risk persists among current sex workers who participate in syringe exchange programmes (SEPs). With data from interviews with randomly selected participants in five US cities, we compared the demographic characteristics, sexual risk behaviours, drug use practices, emotional and physical health, and SEP utilization patterns of currently active female sex workers who attend SEPs with female SEP participants who do not engage in sex work. Data indicate that women enrolled in SEPs who were currently trading sex typically reported greater HIV risk than women non-sex workers. Current sex workers reported higher levels of risk for every drug risk variable examined in bivariate analysis. They were more likely than other women to inject with a syringe previously used by someone else, to inject daily and to attend shooting galleries; they were less likely to use a condom with their primary partners and to report higher levels of psychological distress than their counterparts. The relationship between sex work status and risky injection practices persisted when potential confounders were controlled for in multivariate analysis. SEPs can serve a pivotal role in providing sex workers with services and referrals which would help them reduce risk behaviours.

Acquired Immunodeficiency Syndrome↗

Development of an enhanced needle and syringe programme: the First Step programme pilot.

The First Step programme is a new approach to needle and syringe exchange services established to help intravenous drug users reduce harmful drug use behaviours, provide psychoeducation and act as a point of transition enhancing access to other health and community services. The First Step assertive treatment approach was implemented in a medium-sized community area health service and evaluated over an 18-month period. A pilot evaluation of staff training was also conducted, demonstrating a significant improvement in staff skills in assertive outreach, needs assessment, engagement, psychoeducation and referral. Measures of drug-related harm showed the benefits of new early engagement-enhancing psychoeducational interventions, with increases in needles distributed and returned and greater referrals to drug and alcohol and other health services. Training needle and syringe workers towards a more assertive community outreach role gives them the ability to provide psychoeducation and harm minimization strategies and act as a conduit for intravenous drug users to enter treatment.

Chi-Square Distribution↗

Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales.

The aim of this study was to compare demographic and drug use profiles of non-needle and syringe programmes (NSP) attendees with NSP attendees from the same geographic area. Two data sources were used. One was from an annual national survey of injecting drug users (IDU) at NSP and analysis was restricted to survey sites in Kings Cross and Kogarah in 2003 (NSP survey). The other was from a survey of IDU who do not use NSP as their primary source of injecting equipment within the same broad geographical region (Access survey). Of the total 264 survey participants, 102 had never attended a NSP (non-NSP attendees) and 162 had previous experience of NSP (NSP attendees). Compared with NSP attendees, non-NSP attendees were less likely to report severe drug problems and more likely to report lower prevalence of HIV, hepatitis B and hepatitis C infection. Nevertheless, about 20% of non-NSP attendees reported re-use of needles and syringes after someone else in the previous month. Compared to NSP attendees, a lower rate of usage of health services was reported by non-NSP attendees. Strategies to promote access to NSP and harm reduction services, including testing for blood-borne viruses, information provision and consideration of referral to treatment among non-NSP attendees are recommended.

Adult↗

Reductions in HIV risk behaviour and stable HIV prevalence in syringe-exchange clients and other injectors in England.

Syringe-exchange attenders (n = 86) and a comparison group of injectors not attending exchanges (n = 121) were recruited and interviewed in 1989 to examine HIV risk behaviour and HIV antibody status. In 1990, 59% of attenders and 50% of non-attenders were re-contacted and re-interviewed to examine changes over time. Re-interviewed subjects did not differ demographically or in drug use from those not re-interviewed. At first interview, all were injecting, and 35% of attenders and 42% of non-attenders reported recent syringe-sharing. One year later, levels of HIV-risk were similar for both groups, but risk reduction had been achieved by different routes. At Time 2, 16% of attenders were injecting and sharing (IS), 70% injecting and not sharing (INS), and 14% not injecting (NI), compared to non-attenders, 22% IS, 47% INS and 31% NI. Attenders were more likely to continue injecting (86%) with low sharing (18% of those still injecting). Non-attenders were less likely to continue injecting (69%), but continuing injectors had higher sharing rates (32% of those still injecting). More non-attenders than attenders stopped injecting, but non-attenders who continued to inject were at a higher risk of HIV infection than attenders who continued to inject. Baseline HIV prevalence was 2.5% and there were no sero conversions. The levels of sharing for both groups were lower than levels in the UK before HIV prevention programmes commenced and are lower than 1990 sharing rates in the USA. The study indicates the importance of tracking individual change over time, and of measuring outcomes additional to changes in sharing.

Journal Article↗

Oesophageal manometry. A comparison of hydraulic and syringe catheter infusion systems using a simple hydrostatic bench model.

A simple hydrostatic bench model is described which can be used to validate oesophageal intraluminal manometry measurements. Conventional syringe pump infusion was compared with the hydraulic capillary infusion system using this model. Accurate recording of pressure changes was achieved on the low compliance hydraulic system at infusion rates of 1 X 10(-8) m3 s-1 (0.6 ml min-1). To achieve comparable accuracy with syringe pump infusion, undesirably rapid infusion rates of 10.35 X 10(-8) m3 s-1 (6.2 ml min-1) were required. We believe that the hydrostatic bench model is a useful tool for checking the accuracy of infused catheter systems.

Animals↗

Stability of cisatracurium besylate in vials, syringes, and infusion admixtures.

The stability of cisatracurium besylate was studied. Cisatracurium (as besylate) 2 mg/mL in 5- and 10-mL unopened vials and 10 mg/mL in 20-mL unopened vials, as well as 3 mL of solution from additional 2-mg/mL vials, repackaged in 3-mL sealed plastic syringes, was stored at 4 and 23 degrees C in the dark and in normal fluorescent room light. Admixtures of cisatracurium (as besylate) 0.1, 2, or 5 mg/mL in polyvinyl chloride (PVC) minibags of 5% dextrose injection or 0.9% sodium chloride injection were stored at 4 and 23 degrees C in normal fluorescent room light. Triplicate samples for each storage condition were taken initially and at 1, 3, 5, 7, 14, 21, and 30 days; samples from vials were also removed at 45 and 90 days. Solutions were stored in sterile vials at -70 degrees C and then thawed at room temperature before analysis of chemical stability by high-performance liquid chromatography. Physical stability was assessed as well. Cisatracurium besylate was physically stable in all samples throughout the study. Cisatracurium (as besylate) 2 mg/mL exhibited drug losses at 23 degrees C in vials at 45 days and in syringes at 30 days. Cisatracurium (as besylate) 0.1, 2, and 5 mg/mL in 5% dextrose injection and in 0.9% sodium chloride injection was stable for at least 30 days at 4 degrees C, but substantial drug losses occurred at 23 degrees C. Admixtures prepared with cisatracurium (as besylate) 0.1 mg/mL and with 5% dextrose injection exhibited the greatest losses. Cisatracurium besylate was stable in most samples for at least 30 days at 4 and 23 degrees C; admixtures containing cisatracurium (as besylate) 0.1 or 2 mg/mL exhibited substantial drug loss at 23 degrees C.

Atracurium↗

Cost-effectiveness of tuberculosis screening and observed preventive therapy for active drug injectors at a syringe-exchange program.

This study examined whether costs associated with tuberculosis (TB) screening and directly observed preventive therapy (DOPT) among drug injectors attending a syringe exchange are justified by cases and costs of active TB cases prevented and examined the impact of monetary incentives to promote adherence on cost-effectiveness. We examined program costs and projected savings using observed adherence and prevalence rates and literature estimates of isoniazid (INH) preventive therapy efficacy, expected INH hepatoxicity rates, and TB treatment costs; we conducted sensitivity analyses for a range of INH effectiveness, chest X-ray (CXR) referral adherence, and different strategies regarding anergy among persons affected with human immunodeficiency virus (HIV). For 1,000 patients offered screening, incorporating real observed program adherence rates, the program would avert $179,934 in TB treatment costs, for a net savings of $123,081. Assuming a modest risk of TB among HIV-infected anergic persons, all strategies with regard to anergy were cost saving, and the strategy of not screening for anergy and not providing DOPT to HIV-infected anergic persons resulted in the greatest cost savings. If an incentive of $25 per person increased CXR adherence from the observed 31% to 50% or 100%, over a 5-year follow-up the net cost savings would increase to $170,054 and $414,856, respectively. In this model, TB screening and DOPT at a syringe exchange is a cost-effective intervention and is cost-saving compared to costs of treating active TB cases that would have occurred in the absence of the intervention. This model is useful in evaluating the cost impact of planned program refinements, which can then be tested. Monetary incentives for those referred for screening CXRs would be justified on a cost basis if they had even a modest beneficial impact on adherence.

AIDS-Related Opportunistic Infections↗

Estimation of the number of injecting drug users attending an outreach syringe-exchange program and infection with human immunodeficiency virus (HIV) and hepatitis C virus: the AjUDE-Brasil project.

This study estimated the number of street injecting drug user (IDU) clients of a syringe-exchange program (SEP) who were infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). A two-sample capture-recapture method was carried out. The first capture listed all interviewed IDUs outreached for syringe exchange from April 1 to May 1, 1998; the second capture involved those outreached from May 2 to June 6, 1998. Blood spots were collected for HIV and HCV serologies. Analysis used captured probability model varying with time. We interviewed 55 IDUs in the first capture and 99 in the second; 17 participated in both samples. An estimate of 317 IDUs attending the SEP was obtained (95% confidence interval [CI] 235-467). Based on the overall seroprevalence rates for HIV (47.7%) and HCV (53.1%), it was estimated that 151 IDUs were HIV infected (95% CI 112-223) and 168 (95% CI 125-248) were HCV infected. Enumeration of IDUs associated with estimates of the total number of HIV and HCV seropositives provide a powerful tool for SEPs to help monitor the number of IDUs, to plan for provisions, and to organize the new demands on existing health facilities for HIV and HCV care.

Adult↗

Adherence to hepatitis B virus vaccination at syringe exchange sites.

Injection drug users (IDUs) are at high risk for hepatitis B virus (HBV); however, they often do not receive preventive vaccination. IDUs who use mobile health care services linked to a syringe exchange program in New Haven were routinely screened for HBV, hepatitis C virus, and syphilis. Individuals without prior exposure to HBV were offered three-part vaccination series. Of the 212 IDUs screened for HBV infection, 134 (63%) were eligible (negative for HBV surface and core anti-bodies) for vaccination and 10 (4.7%) had evidence of chronic HBV infection. Compared to those with previous exposure to HBV, vaccine-eligible patients were significantly more likely to be younger and use heroin and less likely to be black, home-less, daily injectors, and cocaine users. Of the 134 vaccine-eligible subjects, 103 (77%) and 89 (66%) completed two and three vaccinations, respectively. Correlates of completing all three vaccinations included older age (OR = 1.06, 95% CI = 1.04-1.07), injecting daily (OR = 2.12, 95% CI = 1.36-6.73), and being homeless (OR = 1.98, 95% CI = 1.14-12.27). These results suggest that IDUs remain at high risk for acquiring HBV infection. Programs that link health care to a syringe exchange program are effective ways to provide preventive health care services to IDUs, particularly HBV vaccination. Trust engendered by and mutual respect afforded by such programs result in repeated encounters by active IDUs over time.

Adult↗