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PubMedDate not supplied

A cross-sectional study on factors including HIV testing and counselling determining unsafe injecting practices among injecting drug users of Manipur.

In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.

AIDS Serodiagnosis↗
PubMed1998

Assisted reproduction by intracytoplasmic sperm injection: a survey on the clinical experience in 1994 and the children born after ICSI, carried out until 31 December 1993. ESHRE Task Force on Intracytoplasmic Sperm Injection. European Society for Human Reproduction and Embryology.

The second report of the ESHRE Task Force on ICSI describes the outcome of 13,666 ICSI cycles carried out in 1994 by 90 centres in 24 countries. Most cycles used ejaculated spermatozoa (94.4%) while epididymal and testicular spermatozoa were used in 4.1% and 1.5% of the cycles. Outcome measures in the three types of spermatozoa included the number of: (i) intact oocytes after ICSI; (ii) normally fertilized oocytes; (iii) transferred and frozen embryos; (iv) embryo transfers and (v) cycles with positive serum HCG. The evolution of the pregnancies was analysed in terms of pregnancy losses and clinical pregnancies. The results of ICSI with spermatozoa from the ejaculate was analysed according to the year that ICSI started in the different centres. The survey also reports the follow-up of children born after ICSI carried out until 31 December 1993. A total of 455 pre- and postnatal karyotypes revealed the presence of nine abnormal karyotypes. Twenty-four centres reported on 807 ICSI children: 763 using ejaculated spermatozoa, 36 using epididymal spermatozoa and eight using testicular spermatozoa. Sixteen major congenital malformations were reported.

Adult↗
PubMed2005

Rapid assessment of injection practices in Cambodia, 2002.

BACKGROUND: Injection overuse and unsafe injection practices facilitate transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Anecdotal reports of unsafe and unnecessary therapeutic injections and the high prevalence of HBV (8.0%), HCV (6.5%), and HIV (2.6%) infection in Cambodia have raised concern over injection safety. To estimate the magnitude and patterns of such practices, a rapid assessment of injection practices was conducted. METHODS: We surveyed a random sample of the general population in Takeo Province and convenience samples of prescribers and injection providers in Takeo Province and Phnom Penh city regarding injection-related knowledge, attitudes, and practices. Injection providers were observed administering injections. Data were collected using standardized methods adapted from the World Health Organization safe injection assessment guidelines. RESULTS: Among the general population sample (n = 500), the overall injection rate was 5.9 injections per person-year, with 40% of participants reporting receipt of >or= 1 injection during the previous 6 months. Therapeutic injections, intravenous infusions, and immunizations accounted for 74%, 16% and 10% of injections, respectively. The majority (>85%) of injections were received in the private sector. All participants who recalled their last injection reported the injection was administered with a newly opened disposable syringe and needle. Prescribers (n = 60) reported that 47% of the total prescriptions they wrote included a therapeutic injection or infusion. Among injection providers (n = 60), 58% recapped the syringe after use and 13% did not dispose of the used needle and syringe appropriately. Over half (53%) of the providers reported a needlestick injury during the previous 12 months. Ninety percent of prescribers and injection providers were aware HBV, HCV, and HIV were transmitted through unsafe injection practices. Knowledge of HIV transmission through "dirty" syringes among the general population was also high (95%). CONCLUSION: Our data suggest that Cambodia has one of the world's highest rates of overall injection usage, despite general awareness of associated infection risks. Although there was little evidence of reuse of needles and syringes, support is needed for interventions to address injection overuse, healthcare worker safety and appropriate waste disposal.

Adolescent↗
PubMed2004

The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons.

BACKGROUND: The use of corticosteroid injections in the treatment of retrocalcaneal bursitis is controversial. We assessed the effects of corticosteroid injections, both within the tendon substance and into the retrocalcaneal bursa, on the biomechanical properties of rabbit Achilles tendons. The systemic effects of bilateral corticosteroid injections were also studied. METHODS: The rabbits were divided into three treatment groups. The rabbits in Group I received injections of corticosteroid into the Achilles tendon on the left side and injections of normal saline solution into the Achilles tendon on the right, those in Group II received injections of corticosteroid into the retrocalcaneal bursa on the left side and injections of saline solution into the Achilles tendon on the right, and those in Group III received injections of corticosteroid into the Achilles tendon on the left side and injections of corticosteroid into the retrocalcaneal bursa on the right. These injections were given weekly for three weeks. At four weeks after the final injection, the tendons were harvested and were tested biomechanically to determine failure load, midsubstance strain and total strain, modulus of elasticity, failure stress, and total energy absorbed. The site of failure was also documented. The groups were compared according to the location of the injections, the type of injection (steroid or saline solution), and the total systemic load of steroid. RESULTS: Specimens from limbs that had received intratendinous injections of corticosteroid showed significantly decreased failure stress compared with those from limbs that had received intratendinous injections of saline solution (p = 0.008). Specimens from limbs that had received intrabursal injections of corticosteroid demonstrated significantly decreased failure stress (p = 0.05), significantly decreased total energy absorbed (p = 0.017), and significantly increased total strain (p = 0.049) compared with specimens from limbs that had received intratendinous injections of saline solution. Specimens from limbs that had received intratendinous injections of corticosteroid were biomechanically equivalent to specimens from limbs that had received intrabursal injections of corticosteroid. Specimens from rabbits that had received bilateral injections of corticosteroid demonstrated significantly decreased failure load (p = 0.011), modulus of elasticity (p = 0.015), failure stress (p = 0.03), and total energy absorbed (p = 0.015) compared with those from rabbits that had received unilateral injections of steroid. CONCLUSIONS: Local injections of corticosteroid, both within the tendon substance and into the retrocalcaneal bursa, adversely affected the biomechanical properties of rabbit Achilles tendons. Additionally, tendons from rabbits that had received bilateral injections of corticosteroid demonstrated an additive adverse effect, with significantly worse biomechanical properties compared with tendons from rabbits that had received unilateral injections of corticosteroid.

Achilles Tendon↗
PubMed1998

Injection sclerotherapy in the treatment of rectal prolapse in infants and children.

PURPOSE: The aim of this study was to examine the efficacy of injection sclerotherapy as treatment for persistent rectal prolapse. METHODS: The records of 28 patients with rectal prolapse treated with injection sclerotherapy over a 16-year period were reviewed. Initial management included assessment and correction of predisposing factors. If rectal prolapse persisted or if the prolapse required repeat emergency or operating room reduction, injection sclerotherapy was performed. The sclerosing agent included D50W in 21 patients (sole agent in 15, combined with ethanolamine oleate in four, and with phenol 5% in two). Phenol 5% alone was used in six patients, and 25% saline was used in one patient. Number of injections, recurrences, and complications were reviewed. RESULTS: Two patients were lost to follow-up, and one patient was cured once a polyp was recognized and removed. Of the remaining 25 patients, 21 were cured. Sixteen required one injection, three required two injections, and two required three injections (64% cure rate after one injection, 84% cure rate after three injections). There were 4 of 25 failures: two went on to low anterior resection after having failed two injections each; one patient was treated with Thiersch cerclage and injection after two failed injections; and one patient did not respond after three injections but had less severe prolapses. Of those injected with D50W alone, 13 of 14 were cured with injection sclerotherapy. Nine received one injection, two received two injections, and two received three injections (64% cure rate after one injection, 93% cure rate after three injections). The only complication was excessive oozing at the injection site in one patient. He was simply observed in hospital overnight. Follow-up averaged 33 months. The only significant underlying abnormality in our patient population was spina bifida in one patient. This patient was cured with injection therapy. Cystic fibrosis was ruled out by clinical examination and sweat chloride test in all patients. Constipation was the most common condition identified with the onset of rectal prolapse (15 of 28). CONCLUSIONS: Injection sclerotherapy is simple and should be considered as the first line treatment of recurrent rectal prolapse after failure of conservative measures. D50W is effective, easily available, inexpensive, and associated with few complications.

Causality↗
PubMed2003

Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood in the needle hub and whether a vascular pattern was noted with contrast injection, and these were correlated. Relevant epidemiologic data also were recorded. RESULTS The study included 504 transforaminal epidural steroid injections. The overall rate of fluoroscopically confirmed intravascular contrast injections was 19.4%. Use of observed blood in the needle hub to predict intravascular injections was 97% specific, but only 45.9% sensitive. There was no significant difference in intravascular rates related to age or gender. CONCLUSIONS As compared with a previous study of lumbosacral epidural steroid injections, there is an overall higher incidence of intravascular injections with cervical transforaminal epidural steroid injections. Use of observed blood in the needle hub to predict an intravascular injection is not sensitive, and therefore the absence of blood in the needle hub despite aspiration is not reliable. The reported sensitivity and specificity rates are similar to lumbar data. Fluoroscopically guided procedures without contrast confirmation instill medications intravascularly, and therefore not in the desired epidural location. This study confirms that there is a need not only for fluoroscopic guidance, but also for contrast instillation in cervical transforaminal epidural steroid injections.

Adult↗
PubMed1996

Stability and compatibility of granisetron hydrochloride in i.v. solutions and oral liquids and during simulated Y-site injection with selected drugs.

The stability and compatibility of granisetron hydrochloride in common i.v. fluids and oral liquids and during simulated Y-site injection with selected drugs were studied. One milliliter of solution containing granisetron 1 mg (as the hydrochloride salt) was added to 50 mL of 5% dextrose injection, 5% dextrose and 0.9% sodium chloride injection, 5% dextrose and 0.45% sodium chloride injection, or 0.9% sodium chloride injection in polyvinyl chloride (PVC) bags and to 5 mL of 5% dextrose injection, 0.9% sodium chloride injection, or bacteriostatic water for injection in polypropylene syringes and stored at room temperature (20 degrees C) for 24 hours. One milliliter of the granisetron hydrochloride injection was added to 50 mL of apple juice, orange juice, cola, or an electrolyte replacement solution and stored for 60 minutes at room temperature. Twenty-nine drugs were mixed with the granisetron hydrochloride injection in 0.9% sodium chloride injection in volumes simulating Y-site injection and stored at room temperature. Finally, dexamethasone sodium phosphate injection 0.5 mL and 1 mL of the granisetron hydrochloride injection were added to 50 mL of 0.9% sodium chloride injection in a PVC bag and stored for 60 minutes. Drug concentrations were determined by high-performance liquid chromatography, and color, clarity, and pH were evaluated. Granisetron hydrochloride was stable in and compatible with all the i.v. solutions and oral liquids. Neither granisetron nor any of the drugs it was tested with during simulated Y-site injection showed any physical changes except for a slight Tyndall effect in the granisetron hydrochloride-doxorubicin hydrochloride combination; all the drugs retained at least 96% of initial concentrations. Granisetron and dexamethasone sodium phosphate were stable and compatible in the admixture. Granisetron 1 mg (as the hydrochloride salt) was stable for 24 hours in four i.v. infusion fluids in PVC bags and in 5% dextrose injection, 0.9% sodium chloride injection, and bacteriostatic water for injection in polypropylene syringes; for 1 hour in four oral liquids; for 4 hours in the presence of each of 29 drugs during simulated Y-site injection; and for 1 hour when mixed with dexamethasone sodium phosphate in 0.9% sodium chloride injection in a PVC bag.

Administration, Oral↗
PubMedDate not supplied

Injection use in a village in north India.

BACKGROUND: Injections can transmit infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and precipitate poliomyelitis. Complications such as injection abscesses and nerve damage may also occur. It is estimated that 50% of the injections given in developing countries are unsafe. However, limited information is available from India. We planned a pilot study to assess the prevalence of injection use and the knowledge of the community and private medical practitioners (PMPs) about injection use. METHODS: One in every four houses in the village under study was selected by systematic random sampling. One adult (> 18 years) respondent in the family was asked questions about family members receiving injections in the past 6 months. Nine PMPs were interviewed about their knowledge and practices regarding injection use. RESULTS: In the past six months, 1280 family members in 285 houses received 1575 injections (2.46 injections per person per year). About 35% had received at least one injection in the past 6 months. Children below 5 years received 3.1 injections/child/year of which about 60% were preventive. On their last visit to a health facility, 55% of the subjects were given injections using disposable syringes. About 45% of the 285 respondents knew that diseases could be spread by improper use of injections. While 18% of the respondents said they would prefer injections, 54% preferred oral medications if both were equally effective. After being told the average cost of disposable needles and syringes, 92% of the respondents were willing to buy them. None of the 9 PMPs practising in the village were formally trained in modern medicine. On the day of observation, 18 of 58 patients (30%) seen by PMPs were given injections. Three injections were observed and though they were all given with disposable syringes, the technique of administration did not follow standard guidelines in any. Two PMPs did not know of any disease transmitted by injections. The syringes were usually thrown in a nearby drain or outside the village. Four PMPs said that patients themselves did not ask for injections. CONCLUSION: The use of injections in the study area was high. The PMPs were not only giving a high number of injections but the technique of administration was also wrong. The community was less likely to ask for injections on their own but was willing to buy disposable syringes and needles. The awareness about the risk of injections was low.

Adult↗