Hepatitis A Virus among Drug Users and the Role of Vaccination: A Review

In countries with advanced economies better health and hygiene conditions, along with the introduction, in some cases, of global vaccination, have relegated most viral hepatitis to marginal social groups and, in particular, drug users (DUs). The availability of safe and effective vaccines for hepatitis A virus (HAV) and B (HBV) may play a major role in combating this phenomenon. Despite the availability of a safe and effective vaccine for over a decade and the recommendations of international health organizations, vaccinations against HAV among DUs are not as widely known and available as are HBV vaccinations. The purpose of this review article is to present the most significant data in the literature on the prevalence of HAV among DUs and the role of targeted vaccination. To our knowledge, the present article is the first to solely deal with vaccination against HAV in DUs. Immunization after the administration of anti-HAV vaccine has been demonstrated in DUs even if they have responded significantly less than either the general population or carriers of chronic liver disease. All the vaccines were well tolerated and adherence to the vaccine schedule was good. Further studies are needed to optimize the timing and doses of vaccine to be administered to DUs, especially to assess adherence and antibody persistence. Vaccination campaigns are feasible among DUs and have proven to be highly cost–effective

Impiego della spettrometria di massa nell'analisi di fumonisine in alimenti e matrici di origine animale

Mycotoxins are heterogeneous chemical compounds characterized by a low molecular weight and synthesized by the secondary metabolism of different molds. Fumonisins are water-soluble mycotoxins produced by Fusarium species spoiling corn and derived produc ts. These mycotoxins can be a health hazard when consuming contaminated cereals, but they can reach humans also indirectly through the consumption of food products derived from animals fed with contaminated feed. Fumonisins have been associated with several animal and human diseases: they are suspected risk factors for esophageal and liver cancers, neural tube defects and cardiovascular problems. Improved methods are needed to accurately assess fumonisins concentrations in food of vegetable and animal origin, in order to prevent acute and chronic human exposure. The aim of the present work was to evaluate the versatility and the performances of mass spectrometry, coupled with liquid chromatography, in fumonisins analysis from foods and matrices of animal origin. Different methods for the identification and quantification of fumonisins and related products have been developed and validated to determine fumonisin B1 in milk, fumonisin B1, fumonisin B2 and their complete hydrolyzed products (HFB1 and HFB2) in pig liver and fumonisins B1 and B2 in complete and complementary dry dog food. The experimental procedures have been carefully studied, considering matrices features, number and type of molecules to detect. Therefore, several extraction, clean up and separation techniques were tested in order to obtain the better conditions of sample processing. The fit for purpose sample preparation, matched with high mass spectrometry sensibility and specificity, have allowed to achieve good results in any tested animal matrices. Hence, the developed methods were validated and have shown a high accuracy, sensibility and precision, fulfilling performance requirements of Decision 2002/657/EC and of European Project Standard, Measuring and Testing (SMT). In any developed method, the analytes were identified and quantified even at very low concentrations : the limits of quantification resulted lower than other similar works, performed with different detectors. These methods were applied to some commercial samples and to some samples collected for research projects in the Department of Veterinary Public Health and Animal Pathology (DVPHAP) of University of Bologna. Although the disclosed data must be considered completely preliminary and without statistical significance, they emphasize the presence of mycotoxins in animal products. The outcomes obtained from the processed samples (bovine milk, pig liver and dry dog food) suggest the efficacy of these methods also on other food matrices, confirming the versatility and the performances of mass spectrometry, coupled with liquid chromatography, in fumonisins analysis. Moreover the results underline the need to set up a large scale monitoring in order to evaluate the presence of fumonisins in food of animal origin for human consumption

Sexual functioning and opioid maintenance treatment in women. Results from a large multicentre study

Opioid maintenance treatment (OMT) is the most widespread therapy for both females and males opioid addicts. While many studies have evaluated the OMT impact on men’s sexuality, the data collected about the change in women’s sexual functioning is still limited despite the fact that it is now well-known that opioids-both endogenous and exogenous-affect the endocrine system and play an important role in sexual functioning. The present study aims to determine how OMT with buprenorphine (BUP) or methadone (MTD) affects sexual health in women; examining also any possible emerging correlation between sexual dysfunction (SD), type of opioid and patients’ mental health. This multi-center study case recruited 258 female volunteers attending Italian public Addiction Outpatients Centers that were stabilized with OMT for at least 3 months. SD was assessed with the Arizona Sexual Experience Scale. The twelve-item General Health Questionnaire was used to assess participants’ mental health conditions. The results show that 56.6% of women receiving OMT for at least 3 months presented SD without significant differences between MTD e BUP groups. The majority of the subjects with SD have a poorer quality of intimate relationships and worse mental health than the average. To the best of our knowledge, the present study is the largest report on the presence of SDs in women as a side effects of MTD and BUP used in OMT. Since SDs cause difficulties in intimate relationships, lower patients’ quality of life and interfere with OMT beneficial outcomes, we recommend that women undertaking an opioid therapy have routine screening for SD and we highlight the importance to better examine opioid-endocrine interactions in future studies in order to provide alternative potential treatments such as the choice of opioid, opioid dose reduction and hormone supplementation

Bloodborne Viral Hepatitis Infections among Drug Users: The Role of Vaccination

Drug use is a prevalent world-wide phenomenon and hepatitis virus infections are traditionally a major health problem among drug users (DUs). HBV and HCV, and to a lesser extent HAV, are easily transmitted through exposure to infected blood and body fluids. Viral hepatitis is not inevitable for DUs. Licensed vaccines are available for hepatitis A and hepatitis B. The purpose of this overview is to show some epidemiological data about HBV and the other blood-borne viral hepatitis among DUs and to summarize and discuss use of hepatitis vaccinations in this population. Successful vaccination campaigns among DUs are feasible and well described. We try to focus on the most significant results achieved in successful vaccination programs as reported in scientific literature. Vaccination campaigns among DUs represent a highly effective form of health education and they are cost-saving

Non-invasive brain stimulation for gambling disorder: a systematic review

Background:Gambling disorder (GD) is the most common behavioral addiction and shares pathophysiological and clinical features with substance use disorders (SUDs). Effective therapeutic interventions for GD are lacking. Non-invasive brain stimulation (NIBS) may represent a promising treatment option for GD. Objective:This systematic review aimed to provide a comprehensive and structured overview of studies applying NIBS techniques to GD and problem gambling. Methods:A literature search using Pubmed, Web of Science, and Science Direct was conducted from databases inception to December 19, 2019, for studies assessing the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (t-DCS) on subjects with GD or problem gambling. Studies using NIBS techniques on healthy subjects and those without therapeutic goals but only aiming to assess basic neurophysiology measures were excluded. Results:A total of 269 articles were title and abstract screened, 13 full texts were assessed, and 11 were included, of which six were controlled and five were uncontrolled. Most studies showed a reduction of gambling behavior, craving for gambling, and gambling-related symptoms. NIBS effects on psychiatric symptoms were less consistent. A decrease of the behavioral activation related to gambling was also reported. Some studies reported modulation of behavioral measures (i.e., impulsivity, cognitive and attentional control, decision making, cognitive flexibility). Studies were not consistent in terms of NIBS protocol, site of stimulation, clinical and surrogate outcome measures, and duration of treatment and follow-up. Sample size was small in most studies. Conclusions:The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the efficacy of NIBS interventions for GD. Further methodologically sound, robust, and well-powered studies are needed

Inovações na linguagem tipográfica: a tensão entre o visual e o verbal na letra fantasia

Dissertação apresentada para obtenção do título de mestre do Programa de Pós-Graduação em Comunicação da Universidade Municipal de São Caetano do SulO propósito dessa pesquisa foi estudar e compreender as inovações na linguagem tipográfica, em especial a letra ilustrada, através das tensões entre os signos visual e verbal como geradores de sentido na comunicação publicitária impressa. Por não existirem definições técnicas exatas da estrutura desse tipo de letra, foi constatado que ela se originou nas iluminuras, mais especificamente nas letras iluminadas capitulares. Verificou-se que a letra ilustrada pode se originar de qualquer categoria tipográfica e tem como característica principal elementos visuais em sua estrutura. Esses elementos formam algum tipo de tensão com os elementos verbais e, uma vez identificadas essas tensões, foi possível organizá-las em arranjos e grupos de acordo com a percepção visual, compreensão do contexto e relação da letra ilustrada com a composição publicitária impressa. A definição de tais arranjos serviu para contribuir no melhor entendimento da letra ilustrada, possibilitando a classificação dos tipos de tensões entre os signos visuais e verbais, e agrupando-as de acordo com suas características predominantes. Pela maior compreensão desse tipo de letra busca-se auxiliar profissionais da área a entenderem a letra ilustrada. O entendimento das tensões resultou na possibilidade de verificação do significado de mensagens contendo esse tipo de letra, bem como de uma inter-relação dos arranjos e outros questionamentos quanto à sua possível aplicação em outras mídias e quanto à extensão de tais arranjos em categorias mais complexas. A letra ilustrada permite ser inovadora pela constituição de novas tensões entre os signos verbal e visual e pelas relações interacionais dos signos com o restante da composição, o que permite o acréscimo de comunicações criativas. Tratou-se de uma pesquisa qualitativa e de natureza exploratória, com revisão bibliográfica, levantamento e análise documental. Fez-se o levantamento quantitativo de anúncios publicitários impressos em revistas da última década, que exibem em sua composição a letra ilustrada, nos anuários do site do Clube da Criação de São Paulo e nos anuários do concurso norte americano Clio Awards, para delimitar o corpus de análise. Pela análise dos anúncios selecionados foi feita a pesquisa qualitativa, tomando a categorização sígnica de Peirce como método semiótic

GOVERNANÇA PÚBLICA E SUSTENTABILIDADE EM INSTITUIÇÕES DE ENSINO

Objetivo: Compreender como as práticas de governança estabelecidas pela unidade administrativa (Reitoria) influenciam na operacionalização das ações de sustentabilidade praticadas pelas unidades universitárias (Campi). Método / abordagem: A presente pesquisa trata-se de um estudo de caso em que houve três fontes de dados: a) documentos (Plano de Desenvolvimento Institucional e o Plano de Gestão); b) Entrevistas com gestores da unidade administrativa, e c) entrevistas com gestores das unidades universitárias. Principais resultados: Foi possível identificar 31 ações ligadas aos mecanismos de governança. Como exemplo, pode-se mencionar “monitoração e administração de aporte de recursos orçamentários para permanência estudantil”. Também foi possível identificar 23 ações de sustentabilidade. Como exemplos pode-se apresentar: a) parceria para eficiência energética; b) internacionalização da pesquisa alinhada aos Objetivos de Desenvolvimento Sustentável da ONU, e c) programa de inclusão. Contribuições metodológicas / sociais / gerenciais: Do ponto de vista teórico, a presente pesquisa contribui no estudo da governança pública voltada para a sustentabilidade em instituição de ensino superior ao apresentar uma dificuldade da instituição de ensino de relacionar as ações de governança pública e sustentabilidade. A pesquisa também contribui para que os gestores de instituições de ensino reflitam sobre como as ações de governança e de sustentabilidade deveriam estar mais relacionadas e alinhadas. Originalidade / relevância: A pesquisa apresenta uma discussão envolvendo os conceitos de governança pública e sustentabilidade. É um tema escasso sobretudo no que tange gestão de instituições de ensino

Continuous Infusion of Flumazenil in the Management of Benzodiazepines Detoxification

An effective approach in the treatment of benzodiazepine (BZD) overdosing and detoxification is flumazenil (FLU). Studies in chronic users who discontinued BZD in a clinical setting suggested that multiple slow bolus infusions of FLU reduce BZD withdrawal symptoms. The aim of this study was to confirm FLU efficacy for reducing BZD withdrawal syndrome by means of continuous elastomeric infusion, correlated to drugs plasma level and patients\u2019 compliance. Methods: Seven-day FLU 1 mg/day subcutaneously injected through an elastomeric pump and BZDs lormetazepam, clonazepam, and lorazepam were assessed by HPLC-MS/MS in serum of patients before and after 4 and 7 days of FLU continuous infusion treatment. Changes in withdrawal severity were assessed by using the BZD Withdrawal Scale (BWS). Results: Fourteen patients (mean age \ub1 SD 42.5 \ub1 8.0 years, 5 male and 9 female), admitted to the hospital for high-dose BZD detoxification, were enrolled in the study. Serum FLU concentrations significantly decreased from 0.54 \ub1 0.33 ng/ml (mean \ub1 SD) after 4 days of treatment to 0.1 \ub1 0.2 ng/ml at the end of infusion. Lormetazepam concentrations were 502.5 \ub1 610.0 ng/ml at hospital admission, 26.2 \ub1 26.8 ng/ml after 4 days, and 0 at the end of treatment. BWS values decreased during FLU treatment temporal period. FLU was well-tolerated by patients. Conclusions: Elastomeric FLU infusion for BZD detoxification is a feasible administration device to maintain adequate, constant, and tolerated FLU concentrations for reducing BZD withdrawal symptoms