Home-based hepatitis C self-testing in people who inject drugs and men who have sex with men in Georgia: a protocol for a randomised controlled trial

Introduction Globally, it is estimated that more than three-quarters of people with chronic hepatitis C virus (HCV) are unaware of their HCV status. HCV self-testing (HCVST) may improve access and uptake of HCV testing particularly among key populations such as people who inject drugs (PWID) and men who have sex with men (MSM) where HCV prevalence and incidence are high and barriers to accessing health services due to stigma and discrimination are common. Methods and analysis This randomised controlled trial compares an online programme offering oral fluid-based HCVST delivered to the home with referral to standard-of-care HCV testing at HCV testing sites. Eligible participants are adults self-identifying as either MSM or PWID who live in Tbilisi or Batumi, Georgia, and whose current HCV status is unknown. Participants will be recruited through an online platform and randomised to one of three arms for MSM (courier delivery, peer delivery and standard-of-care HCV testing (control)) and two for PWID (peer delivery and standard-of-care HCV testing (control)). Participants in the postal delivery group will receive an HCVST kit delivered by an anonymised courier. Participants in the peer delivery groups will schedule delivery of the HCVST by a peer. Control groups will receive information on how to access standard-of-care testing at a testing site. The primary outcome is the number and proportion of participants who report completion of testing. Secondary outcomes include the number and proportion of participants who (a) receive a positive result and are made aware of their status, (b) are referred to and complete HCV RNA confirmatory testing, and (c) start treatment. Acceptability, feasibility, and attitudes around HCV testing and cost will also be evaluated. The target sample size is 1250 participants (250 per arm)

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Multi-messenger Observations of a Binary Neutron Star Merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ∼ 1.7 {{s}} with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of {40}-8+8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 {M}ȯ . An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ∼ 40 {{Mpc}}) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ∼ 9 and ∼ 16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta.</p

Krótkoterminowy wpływ terapii atorwastatyną i ezetimibem w porównaniu z monoterapią atorwastatyną na stan kliniczny chorych z ostrym zespołem wieńcowym w zależności od płci

Background: Atorvastatin reduces low-density lipoprotein cholesterol (LDL-C) levels and the risk of cardiovascular events, but whether the addition of ezetimibe (EZE), a non-statin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further, and if there any sex differences, is not known. Aim: To evaluate the effects of atorvastatin and EZE combination in acute coronary syndrome (ACS) patients on the incidence of composite endpoint in short-term follow-up and to assess differences according their gender. Methods: We conducted a 16-week, single-centre, prospective, randomised, open-label clinical trial involving 323 patients who had been hospitalised for an ACS within the preceding 14 days. They received atorvastatin 20 mg for 28 days, and after that 292 patients who had LDL-C levels ≥ 1.81 mmol/L were randomised to EZE 10 mg/day co-administered with atorvastatin therapy (EZE + statin) or double their current atorvastatin dose. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalisation, coronary revascularisation (≥ 30 days after randomisation), or nonfatal stroke. Results: The Kaplan-Meier event-free survival rate at 16 weeks was 88.1% in the EZE + statin group patients and 77.0% in the atorvastatin monotherapy group (absolute risk reduction: 11.1 percentage points; hazard ratio: 2.099; 95% confidence interval: 1.165–3.781; p = 0.014). The log rank test indicated that there was not a statistically significant difference between male and female survival rates in both treatment groups (p = 0.897). Conclusions: The results of our study demonstrated that when added to statin therapy, EZE resulted in improved cardiovascular outcomes, and the response to atorvastatin and EZE combination was similar for both men and women.Wstęp: Atorwastatyna zmniejsza stężenie frakcji cholesterolu lipoprotein o małej gęstości (LDL) oraz ryzyko zdarzeń sercowo-naczyniowych. Jednak nie wiadomo, czy dołączenie ezetimibu (EZE), leku nienależącego do statyn, który ogranicza jelitową absorpcję cholesterolu, może spowodować dodatkową redukcję częstości zdarzeń sercowo-naczyniowych i czy istnieją różnice zależne od płci. Cel: Badanie przeprowadzono w celu oceny wpływu stosowania terapii skojarzonej atorwastatyną i EZE u chorych z ostrym zespołem wieńcowym (ACS) na występowanie złożonego punktu końcowego w obserwacji krótkoterminowej oraz analizy różnic zależnych od płci. Metody: Do tego trwającego 16 tygodni, jednoośrodkowego, prospektywnego badania z randomizacją, przeprowadzonego metodą otwartej próby, włączono 323 chorych hospitalizowanych z powodu ACS, który wystąpił w ciągu ostatnich 14 dni. Pacjentom podawano atorwastatynę w dawce 20 mg przez 28 dni, a następnie 292 chorych, u których stężenie cholesterolu frakcji LDL wynosiło ≥ 1,81 mmol/l, przydzielono losowo do grupy otrzymującej EZE w dawce 10 mg/d. w skojarzeniu z atorwastatyną (EZE + statyna) lub do leczenia samą atorwastatyną w dawce 2-krotnie większej niż dotychczas stosowana. Główny punkt końcowy obejmował: zgon sercowo-naczyniowy, zawał serca niezakończony zgonem, niestabilną dławicę pier­siową wymagającą hospitalizacji, rewaskularyzację wieńcową (≥ 30 dni po randomizacji) i udar serca niezakończony zgonem. Wyniki: Określony na podstawie analizy przeżycia Kaplana-Meiera odsetek chorych, u których w ciągu 16 tygodni nie wystąpiły zdarzenia zaliczane do punktu końcowego, wynosił 88,1% w grupie terapii skojarzonej EZE + statyna i 77,0% w grupie stosującej monoterapię atorwastatyną (bezwzględne zmniejszenie ryzyka wyniosło 11,1 punktu procentowego; hazard względny: 2,099; 95% przedział ufności: 1,165–3,781; p = 0,014). W teście logarytmicznym rang stwierdzono brak statystycznie istotnych różnic pomiędzy kobietami i mężczyznami między odsetkiem przeżycia bez wystąpienia zdarzeń w obu grupach terapeutycznych (p = 0,897). Wnioski: Wyniki badania dowodzą, że dołączenie EZE do terapii statyną pozwala uzyskać poprawę w zakresie ryzyka sercowo-naczyniowego, a odpowiedź na leczenie skojarzone EZE + statyna była podobna w przypadku obu płci

Phytochemical Study of Endemic Species Helleborus Caucasicus and Helleborus Abchasicus

The floristic region of Adjara represents the "Hotpoint" of Caucasians, which is distinguished by the uniqueness of its relict Colchis flora. It represents one of the most powerful refuges in western Eurasia, which is not touched by the chill because of its special geographical location. 176 endemic plants are spread in southern Colchis, of which 45 can be used for some medical treatments. The bioecology and detailed phytochemical content of some medicinal plant populations have not been studied so far. The research objective is to study the phytochemical content of endemic species of Helleborus Caucasicus and Helleborus Abchasicus that have spread in southern Colchis. The research method for the phytochemical content included the separation analysis, which was performed using UPLC-MS (Waters Acquity QDa detector). Three Steroidal glycosides were isolated from the MeOH extract of the plants of Helleborus Caucasicus and Helleborus Abchasicus: Hellebrigenin-D-glucose, 20 – Hydroxyecdysone and Hydroxyecdysone – 3 glucoside. Three Steroidal glycosides and Hydroxyecdysone -3 glucoside have been isolated from the MeOH extract of Helleborus Caucasicus. Doi: 10.28991/HIJ-2020-01-01-04 Full Text: PD

Implementing a pilot study of COVID-19 self-testing in high-risk populations and remote locations: results and lessons learnt

Abstract Background Rapid antigen-detection tests for SARS-CoV-2 self-testing represent a useful tool for pandemic control and expanding access to community-level case screening. COVID-19 self-tests have been extensively used in high-income countries since 2021; however, their introduction and programmatic implementation in low- and middle-income countries was delayed. We aimed to identify and continuously improve a weekly COVID-19 self-testing model among staff at healthcare facilities and schools. Methods This mixed-methods, observational prospective study was conducted in 5 healthcare centres and 24 schools in Georgia, between June and December 2022. The study comprised the integration of COVID-19 self-testing into the national mandatory testing programme for high-risk groups, with primary distribution of self-tests among staff performed weekly, plus secondary distribution to their household members. These use cases were selected because NCDC was seeking to strengthen their already strong weekly testing programme, by investigating self-testing to ease the burden of testing in the healthcare system. Online surveys and semi-structured interviews were used for data collection. Results In total, 2156 participants were enrolled (1963 female, 72%). At baseline and mid- and end-points, 88%, 97% and 99%, respectively, of participants agreed/strongly agreed they would self-test. Similarly, the majority were willing to report their self-testing results (88%, 98% and 96% at baseline and mid- and end-points, respectively). Weekly reporting of test results to the national COVID-19 database was high during all the implementation. There were 622 COVID-19 positive results reported, and linked to care, from 601 individuals (282 participants and 319 household members). Findings from qualitative interviews showed great satisfaction with self-testing for its convenience, ease of use, trust in the results, no need to travel for diagnostics, and increased perception of safety. Conclusions Our findings contribute to the evidence-base regarding self-testing strategies conducted via workplaces and secondary distribution to households. Willingness to perform a COVID-19 self-test increased after implementation. This pilot enhanced pandemic preparedness through expansion of the national self-testing reporting system, development of communications materials, changes in the national legal framework and coordination mechanisms, and improved perceptions around self-care in the community. The lessons learnt can inform operational aspects of the introduction and scale-up of self-care strategies

Multi-messenger Observations of a Binary Neutron Star Merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of $\sim$1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg$^2$ at a luminosity distance of $40^{+8}_{-8}$ Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Msun. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at $\sim$40 Mpc) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over $\sim$10 days. Following early non-detections, X-ray and radio emission were discovered at the transient's position $\sim$9 and $\sim$16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. (Abridged