online canadian pharmacy http://www.canadianpharmacy365.net/ pharmacy ratings phentermine no prescription

SIGNpost 00866

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00866 Abstracts + HepB Brazil + iContraceptives + News 17 August 2016

CONTENTS
1. Abstract: Epidemiology of hepatitis B virus in the cities of the
northern region of Espírito Santo, Brazil
2. Abstract: Activity-based costing analysis of the analgesic treatments
used in postoperative pain management in Italy
3. Abstract: Epidemiology of hepatitis C virus and genotype distribution
in immigrants crossing to Europe from North and sub-Saharan Africa
4. Abstract: Factors associated with needle sharing among people who
inject drugs in Yunnan, China: a combined network and regression
analysis
5. Abstract: The acceptability of three vaccine injections given to
infants during a single clinic visit in South Africa
6. Abstract: Update on hormonal contraceptive methods and risk of HIV
acquisition in women: a systematic review of epidemiological evidence,
2016
7. Abstract: Risk of HIV-1 acquisition among women who use different types
of injectable progestin contraception in South Africa: a prospective
cohort study
8. Abstract: Phase 3, open-label, randomized study of the
pharmacokinetics, efficacy and safety of ixekizumab following
subcutaneous administration using a prefilled syringe or an
autoinjector in patients with moderate-to-severe plaque psoriasis
(UNCOVER-A)
9. Abstract: Cosmetic Fillers: Perspectives on the Industry
10. Abstract: Hyaluronic acid injection via a pneumatic microjet device to
improve forehead wrinkles
11. No Abstract: Awareness and practices regarding biomedical waste
management among health-care workers in a tertiary care hospital in
Delhi: Comment
12. News
– India: An Egyptian lesson in India’s fight against growing Hepatitis
– Pakistan: Alarming Situation: Congo virus claims another life in Multan
– Global Needlestick Safety Injection Devices Market 2016- Medtronic, BD,
Smiths Group, West Pharmaceuticals

The web edition of SIGNpost is online at:

SIGNpost 00866

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign.moderator@gmail.com

Normally, items received by Tuesday will be posted in the Wednesday
edition.

Subscribe or unsubscribe by email: signmoderator@googlegroups.com

Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

Visit the SIGNpostOnline archives at: http://signpostonline.info

Like SIGNpost on Facebook at: https://www.facebook.com/SIGN.Moderator
and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________

Subscribe or unsubscribe by email to: sign.moderator@gmail.com
or signmoderator@googlegroups.com
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Epidemiology of hepatitis B virus in the cities of the
northern region of Espírito Santo, Brazil
__________________________________________________________________

https://dx.doi.org/10.1590/0001-3765201620150140

An Acad Bras Cienc. 2016 Aug 4;0:0.
Epidemiology of hepatitis B virus in the cities of the northern region of
Espírito Santo, Brazil.

Fontes AM1, Ardisson JS1, Souza MA2, Freitas RR3, Pancoto JA1.

1Universidade Federal do Espírito Santo, Departamento de Ciências
Farmacêuticas, Avenida Marechal Campos, 1468, Bairro Maruípe, 29043-900
Vitória, ES, Brasil.
2Universidade Federal do Espírito Santo, Departamento de Ciências da
Saúde, Rodovia BR 101 Norte, Km 60, Bairro Litoranêo, 29932-540 São
Mateus, ES, Brasil.
3Universidade Federal do Espírito Santo, Departamento de Engenharia e
Tecnologia, Rodovia BR 101 Norte, Km 60, Bairro Litoranêo, 29932-540 São
Mateus, ES, Brasil.

The World Health Organization (WHO) estimates that approximately 2 billion
people worldwide have already had contact with hepatitis B virus (HBV) and
373 million have become chronic carriers. Hepatitis B is a major cause of
chronic hepatitis, cirrhosis and hepatocellular carcinoma, leading to a
large number of deaths annually. Both viral factors and the host immune
response have been implicated in the pathogenesis and clinical result of
HBV infection.

Many Brazilian cities, including the cities of the northern region of the
state of Espírito Santo are located in regions with little health
infrastructure.

Our study performed an epidemiological analysis of cases of Hepatitis B in
São Mateus, using methodology of Geographic Information System (GIS),
aiming to raise the number of disease cases, establishing preventive
measures to control the disease, improving the quality of life of people
affected by this pathology.

The city of São Mateus had the largest number of reported cases of
hepatitis B northern region of Espírito Santo. The age group with the
highest number of hepatitis B notifications was 20-49 years, mostly
females.

*** The major forms of contact with HBV in these cities were dental
treatment, use of injectable medications, surgical procedures and multiple
sexual partners.

Free full text https://dx.doi.org/10.1590/0001-3765201620150140
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Activity-based costing analysis of the analgesic treatments
used in postoperative pain management in Italy
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26999384

Minerva Med. 2016 Feb;107(1):1-13.
Activity-based costing analysis of the analgesic treatments used in
postoperative pain management in Italy.

Fanelli A1, Ruggeri M, Basile M, Cicchetti A, Coluzzi F, Della Rocca G, Di
Marco P, Esposito C, Fanelli G, Grossi P, Leykin Y, Lorini FL, Paolicchi
A, Scardino M, Corcione A.

1Department of Medical and Surgical Sciences, Anesthesia and Pain Therapy,
S. Orsola-Malpighi Polyclinic, Bologna, Italy – andrea.fanelli@aosp.bo.it.

BACKGROUND:
The aim of this analysis is to evaluate the costs of 72-hour postoperative
pain treatment in patients undergoing major abdominal, orthopedic and
thoracic procedures in nine different Italian hospitals, defined as the
cumulative cost of drugs, consumable materials and time required for
anesthesiologists, surgeons and nurses to administer each analgesic
technique.

METHODS: Nine Italian hospitals have been involved in this study through
the administration of a questionnaire aimed to acquire information about
the Italian clinical practice in terms of analgesia. This study uses
activity-based costing (ABC) analysis to identify, measure and give value
to the resources required to provide the therapeutic treatment used in
Italy to manage the postoperative pain patients face after surgery. A
deterministic sensitivity analysis (DSA) has been performed to identify
the cost determinants mainly affecting the final cost of each treatment
analyzed. Costs have been reclassified according to three surgical macro-
areas (abdominal, orthopedic and thoracic) with the aim to recognize the
cost associated not only to the analgesic technique adopted but also to
the type of surgery the patient faced before undergoing the analgesic
pathway.

RESULTS: Fifteen different analgesic techniques have been identified for
the treatment of moderate to severe pain in patients who underwent a major
abdominal, orthopedic or thoracic surgery.

The cheapest treatment actually employed is the oral administration
“around the clock” (€ 8.23), whilst the most expensive is continuous
peripheral nerve block (€ 223.46). The intravenous patient-controlled
analgesia costs € 277.63.

In terms of resources absorbed, the non-continuous administration via
bolus is the gold standard in terms of cost-related to the drugs used (€
1.28), and when administered pro re nata it also absorbs the lowest amount
of consumables (€0.58€) compared to all other therapies requiring a
delivery device.

The oral analgesic administration pro re nata is associated to the lowest
cost in terms of health professionals involved (€ 6.25), whilst
intravenous PCA is the most expensive one (€ 245.66), requiring a massive
monitoring on the part of physicians and nurses.

CONCLUSIONS: The analysis successfully collected information about costs
of 72-hour postoperative pain treatment in patients undergoing major
abdominal, orthopedic and thoracic procedures in all the nine different
Italian hospitals. The interview showed high heterogeneity in the
treatment of moderate to severe pain after major abdominal, orthopedic and
thoracic surgeries among responding anesthesiologists, with 15 different
analgesic modalities reported.

The majority of the analgesic techniques considered in the analysis is not
recommended by any guideline and their application in real life can be one
of the reasons for the high incidence of uncontrolled pain, which is still
reported in the postoperative period. Health care costs have become more
and more important, although the choice of the best analgesic treatment
should be a compromise between efficacy and economic considerations.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Epidemiology of hepatitis C virus and genotype distribution
in immigrants crossing to Europe from North and sub-Saharan Africa
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27502972

Travel Med Infect Dis. 2016 Aug 5. pii: S1477-8939(16)30074-6.
Epidemiology of hepatitis C virus and genotype distribution in immigrants
crossing to Europe from North and sub-Saharan Africa.

Daw MA1, El-Bouzedi A2, Ahmed MO3, Dau AA4, Agnan MM5; In association with
the Libyan Study Group of Hepatitis & HIV.
Author information
1Department of Medical Microbiology, Faculty of Medicine, CC 82668,
Tripoli, Libya; Clinical Microbiology & Microbial Epidemiology, Acting
Physician of Internal Medicine, Scientific Coordinator of Libyan National
Surveillance Studies of Viral Hepatitis & HIV, Tripoli, Libya. Electronic
address: mohamedadaw@gmail.com.
2Department of Laboratory Medicine, Faculty of Biotechnology, CC 82668,
Tripoli, Libya. Electronic address: abdallaelbouzedi@gmail.com.
3Department of Microbiology and Parasitology, Faculty of Veterinary, CC
82668, Tripoli, Libya. Electronic address: libyainformation@gmail.com.
4Department of Surgery, Tripoli Medical Centre, Faculty of Medicine, CC
82668, Tripoli, Libya. Electronic address: dautmc@gmail.com.
5Department of Pharmacology, Faculty of Medical Technology, Alga-bal
Algarbi University, Libya. Electronic address: madaw@consultant.com.

BACKGROUND: The association between the prevalence of hepatitis C virus
(HCV) and immigration is rarely studied, particularly for the immigrants
crossing to the resettlement countries. Most of the published data are
confined to those immigrants who were resident in European countries and
rarely immigrated before they reach the final destination. Libya is a
large country in North Africa with the longest coast of the Mediterranean
Sea facing the European Union. It has been considered as the main
transient station for African immigrants to Europe. The objectives of this
study were to determine: (1) the prevalence of HCV in African immigrants
gathered in Libya from different African countries on their way to Europe
and (2) HCV genotype distribution in these immigrants and its correlation
with different demographic factors.

METHODS: A total of 14 205 serum samples were collected in a 3-year period
(2013-2015) from different immigrants from North and sub-Saharan Africa
who resided in the African immigrant campus, Tripoli, Libya. The
participants were interviewed, and relevant information was collected,
including socio-demographic, ethnic, and geographic variables. Each serum
sample was tested for anti-HCV antibody using ELISA. The genotypes were
determined and assigned using a specific genotyping assay and correlated
with demographic and potential risk factors of the recruited individuals.

RESULTS: Of the immigrants studied, 1078 (7.6%) were positive for HCV. The
prevalence of HCV infection ranged from 1.4% to 18.7%; it was higher among
individuals arriving from Nile river (3.6-18.7%) of North Africa, followed
by those who arrived from the West African region (2.1-14.1%), Horn of
Africa (HOA, 6.8-9.9%), and Maghreb countries (1.4-2.7%). The relative
risk factor attributable to gender variation was not significant (95% Cl:
0.8513-1.2381). Five genotypes were detected in 911 African immigrants.
Genotypic analysis showed that the predominant HCV genotypes in this group
were genotypes 4, 1, and 2 that accounted for 329 (36.1%), 326 (35.8%),
and 131 (14.4%) strains, respectively, followed by genotype 3 that
accounted for 87 (9.5%) strains. Genotype 5 was isolated mainly from 18
HOA (2%) and 20 West African (2.2%) individuals.

CONCLUSIONS: The prevalence of HCV is considered high with a unique
disparate distribution among African immigrants crossing to Europe. This
indicated that the prevalence of HCV is high among these immigrants and
thus may be reflected on the HCV prevalence in the guest countries. The
broad genetic heterogeneity of HCV genotypes detected here may impact the
efficacy of prevention and control efforts for HCV in both Europe and
North and sub-Saharan Africa; hence, an integrated global policy of
actions is needed.

Copyright © 2016. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Factors associated with needle sharing among people who
inject drugs in Yunnan, China: a combined network and regression
analysis
__________________________________________________________________

https://idpjournal.biomedcentral.com/articles/10.1186/s40249-016-0169-y

Infect Dis Poverty. 2016 Aug 9;5(1):73. Free Full Article
Factors associated with needle sharing among people who inject drugs in
Yunnan, China: a combined network and regression analysis.

Chen X1,2, Zhu L1,2, Zhou YH1,3, Liu FL1, Li H4, Yao ZH1, Duo L5, Pang W1,
Ye M1,2, Zheng YT6.

1Key Laboratory of Animal Models and Human Disease Mechanisms of the
Chinese Academy of Sciences and Yunnan Province, Kunming Institute of
Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.
2Kunming College of Life Science, University of Chinese Academy of
Sciences, Kunming, Yunnan, 650204, China.
3College of Life Sciences, Yan’an University, Yan’an, Shaanxi, 716000,
China.
4Yunnan Center for Disease Control and Prevention, Kunming, Yunnan,
650022, China.
5The Second People’s Hospital of Yunnan Province, Kunming, Yunnan, 650021,
China.
6Key Laboratory of Animal Models and Human Disease Mechanisms of the
Chinese Academy of Sciences and Yunnan Province, Kunming Institute of
Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China.
zhengyt@mail.kiz.ac.cn.

BACKGROUND: Network analyses have been widely utilized to evaluate large
datasets, but have not yet been used to explore factors associated with
risk behaviours. In combination with traditional regression analysis,
network analyses may provide useful information and highlight key factors
for reducing needle sharing behaviours among people who inject drugs
(PWID).

METHODS: Sociodemographic data, and information on injection behaviour and
sexual practices were collected from a cross-sectional survey that was
conducted with PWID in five prefectures of Yunnan province, China. A
combination of logistic regression and correlation network analyses were
used to explore key factors for reducing needle-sharing behaviours among
PWID.

RESULTS: In a total of 1 049 PWID, 37.5 % had a history of needle or
syringe sharing. The logistic analysis showed that Zhaotong, Qujing,
Dehong, or Lincang residents, diazepam use, longer injection duration,
needle reuse, and infection with HIV, viral hepatitis, tuberculosis and/or
malaria were independently associated with needle sharing. The correlation
network analyses showed that, compared to PWID who had never shared
needles, PWID who did share needles would achieve harm reduction goals
faster and more permanently. HIV serostatus and marital status were found
to be closely associated with other risk factors. By combining regression
analyses with network analyses, it was shown that PWID who are HIV
seropositive will be an ideal target group for harm reduction programs.

CONCLUSION: Needle-sharing behaviours are common among PWID in Yunnan, and
harm reduction programs may help PWID who are HIV seropositive reduce risk
behaviours and prevent blood borne diseases.

KEYWORDS: China; Needle sharing; Network analysis; People who inject
drugs; Regression analysis; Risk behaviours
__________________________________________________________________
________________________________*_________________________________

5. Abstract: The acceptability of three vaccine injections given to
infants during a single clinic visit in South Africa
__________________________________________________________________

https://dx.doi.org/10.1186/s12889-016-3324-2 Free Full Article

BMC Public Health. 2016 Aug 8;16:749.
The acceptability of three vaccine injections given to infants during a
single clinic visit in South Africa.

Tabana H1,2, Dudley LD3, Knight S4, Cameron N2, Mahomed H2,5, Goliath
C2,5, Eggers R6, Wiysonge CS2,7.

1School of Public Health, Community and Health Sciences, University of the
Western Cape, Cape Town, South Africa.
2Division of Community Health, Faculty of Medicine and Health Sciences,
Stellenbosch University, Cape Town, South Africa.
3Division of Community Health, Faculty of Medicine and Health Sciences,
Stellenbosch University, Cape Town, South Africa. ldudley@sun.ac.za.
4School of Nursing and Public Health, College of Health Sciences,
University of KwaZulu-Natal, Durban, South Africa.
5Metro District Health Services, Western Cape Government: Health, Cape
Town, South Africa.
6Department of Immunizations, Vaccines and Biologicals, World Health
Organization, Geneva, Switzerland.
7Centre for Evidence-based Health Care, Faculty of Medicine and Health
Sciences, Stellenbosch University, Cape Town, South Africa.

BACKGROUND: The Expanded Programme on Immunisation (EPI) has increased the
number of antigens and injections administered at one visit. There are
concerns that more injections at a single immunisation visit could
decrease vaccination coverage. We assessed the acceptability and
acceptance of three vaccine injections at a single immunisation visit by
caregivers and vaccinators in South Africa.

METHODS: A mixed methods exploratory study of caregivers and vaccinators
at clinics in two provinces of South Africa was conducted. Quantitative
and qualitative data were collected using questionnaires as well as
observations of the administration of three-injection vaccination
sessions.

RESULTS: The sample comprised 229 caregivers and 98 vaccinators.
Caregivers were satisfied with the vaccinators’ care (97 %) and their
infants receiving immunisation injections (93 %). However, many
caregivers, (86 %) also felt that three or more injections were excessive
at one visit. Caregivers had limited knowledge of actual vaccines
provided, and reasons for three injections. Although vaccinators
recognised the importance of informing caregivers about vaccination, they
only did this sometimes. Overall, acceptance of three injections was high,
with 97 % of caregivers expressing willingness to bring their infant for
three injections again in future visits despite concerns about the pain
and discomfort that the infant experienced. Many (55 %) vaccinators
expressed concern about giving three injections in one immunisation visit.
However, in 122 (95 %) observed three-injection vaccination sessions, the
vaccinators administered all required vaccinations for that visit. The
remaining seven vaccinations were not completed because of vaccine stock-
outs.

CONCLUSIONS: We found high acceptance by caregivers and vaccinators of
three injections. Caregivers’ poor understanding of reasons for three
injections resulted from limited information sharing by vaccinators for
caregivers. Acceptability of three injections may be improved through
enhanced vaccinator-caregiver communication, and improved management of
infants’ pain. Vaccinator training should include evidence-informed ways
of communicating with caregivers and reducing injection pain. Strategies
to improve acceptance and acceptability of three injections should be
rigorously evaluated as part of EPI’s expansion in resource-limited
countries.

KEYWORDS: Acceptability; Acceptance; Expanded Programme on Immunisation;
Immunisation coverage; Three injections

Free BMC Article https://dx.doi.org/10.1186/s12889-016-3324-2
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Update on hormonal contraceptive methods and risk of HIV
acquisition in women: a systematic review of epidemiological evidence,
2016
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27500670

AIDS. 2016 Aug 5.
Update on hormonal contraceptive methods and risk of HIV acquisition in
women: a systematic review of epidemiological evidence, 2016.

Polis CB1, Curtis KM, Hannaford PC, Phillips SJ, Chipato T, Kiarie JN,
Westreich DJ, Steyn PS.

1aGuttmacher Institute, New York, New York, USA bDepartment of
Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA cDivision of Reproductive Health, Centers for Disease Control and
Prevention (CDC), Atlanta, GA, USA dCentre of Primary Academic Care,
University of Aberdeen, United Kingdom eDepartment of Family Medicine,
Boston University School of Medicine/Boston Medical Center, Boston, MA,
USA fUniversity of Zimbabwe College of Health Sciences, Department of
Obstetrics and Gynecology, Harare, Zimbabwe gDepartment of Reproductive
Health and Research, World Health Organization (WHO), Geneva, Switzerland
hDepartment of Epidemiology, University of North Carolina, Chapel Hill,
NC, USA.

OBJECTIVE AND DESIGN: Some studies suggest that specific hormonal
contraceptive (HC) methods (particularly depot medroxyprogesterone acetate
[DMPA]) may increase women’s HIV acquisition risk. We updated a systematic
review to incorporate recent epidemiological data.

METHODS: We searched for articles published between 1/15/2014-1/15/2016,
and hand- searched reference lists. We identified longitudinal studies
comparing users of a specific HC method against either (1) non-users of
HC, or (2) users of another specific HC method. We added newly identified
studies to those in the previous review, assessed study quality, created
forest plots to display results, and conducted a meta-analysis for data on
DMPA versus no HC.

RESULTS: We identified ten new reports: five were considered “unlikely to
inform the primary question”. We focus on the other five reports, along
with 9 from the previous review, considered “informative but with
important limitations”. The preponderance of data for oral contraceptive
pills, injectable norethisterone enanthate (NET-EN), and levonorgestrel
implants do not suggest an association with HIV acquisition, though data
for implants are limited. The new, higher-quality studies on DMPA (or non-
disaggregated injectables), which had mixed results in terms of
statistical significance, had hazard ratios (HR) between 1.2 and 1.7,
consistent with our meta-analytic estimate for all higher-quality studies
of HR 1.4.

CONCLUSIONS: While confounding in these observational data cannot be
excluded, new information increases concerns about DMPA and HIV
acquisition risk in women. If the association is causal, the magnitude of
effect is likely =HR 1.5. Data for other hormonal contraceptive methods,
including NET-EN, are largely reassuring.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Risk of HIV-1 acquisition among women who use different types
of injectable progestin contraception in South Africa: a prospective
cohort study
__________________________________________________________________

http://dx.doi.org/10.1016/S2352-3018(15)00058-2 Free Full Article

Lancet HIV. 2015 Jul;2(7):e279-87.
Risk of HIV-1 acquisition among women who use different types of
injectable progestin contraception in South Africa: a prospective cohort
study.

Noguchi LM, Richardson BA, Baeten JM, Hillier SL, Balkus JE, Chirenje ZM,
Bunge K, Ramjee G, Nair G, Palanee-Phillips T, Selepe P, van der Straten
A, Parikh UM, Gomez K, Piper JM, Watts DH, Marrazzo JM; VOICE Study Team.

BACKGROUND: Several observational studies have reported that HIV-1
acquisition seems to be higher in women who use depot medroxyprogesterone
acetate (DMPA) than in those who do not use hormonal contraception. We
aimed to assess whether two injectable progestin-only contraceptives, DMPA
and norethisterone enanthate (NET-EN), confer different risks of HIV-1
acquisition.

METHODS: We included data from South African women who used injectable
contraception while participating in theVOICE study, a multisite,
randomised, placebo-controlled trial that investigated the safety and
efficacy of three formulations of tenofovir for prevention of HIV-1
infection in women between Sept 9, 2009, and Aug 13, 2012. Women were
assessed monthly for contraceptive use and incident infection. We
estimated the difference in incident HIV-1infection between DMPA and NET-
EN users by Cox proportional hazards regression analyses in this
prospective cohort. The VOICE trial is registered with ClinicalTrials.gov,
NCT00705679.

FINDINGS: 3141 South African women using injectable contraception were
included in the present analysis: 1788 (56·9%)solely used DMPA, 1097
(34·9%) solely used NET-EN, and 256 (8·2%) used both injectable types at
different times during follow-up. During 2733·7 person-years of follow-up,
207 incident HIV-1 infections occurred (incidence7·57 per 100 person-
years, 95% CI 6·61–8·68). Risk of HIV-1 acquisition was higher among DMPA
users (incidence 8·62 per 100 person-years, 95% CI 7·35–10·11) than among
NET-EN users (5·67 per 100 person-years, 4·35–7·38;hazard ratio 1·53, 95%
CI 1·12–2·08; p=0·007). This association persisted when adjusted for
potential confoundingvariables (adjusted hazard ratio [aHR] 1·41, 95% CI
1·06–1·89; p=0·02). Among women seropositive for herpes simplex virus type
2 (HSV-2) at enrolment, the aHR was 2·02 (95% CI 1·26–3·24) compared with
1·09 (0·78–1·52)for HSV-2-seronegative women (pinteraction=0·07).

INTERPRETATION: Although moderate associations in observational analyses
should be interpreted with caution, thesefi ndings suggest that NET-EN
might be an alternative injectable drug with a lower HIV risk than DMPA in
high HIV-1 incidence settings where NET-EN is available.

FUNDING: National Institutes of Health, Mary Meyer Scholars Fund, and the
Ruth Freeman Memorial Fund.

Comment in

Interpretation, communication, and mechanisms of associations between
injectable contraception and HIV risk. [Lancet HIV. 2015]

Interpretation, communication, and mechanisms of associations between
injectable contraception and HIV risk. [Lancet HIV. 2015]

Interpretation, communication, and mechanisms of associations between
injectable contraception and HIV risk – Authors’ reply. [Lancet HIV. 2015]

DMPA use and HIV acquisition: time to switch to NET-EN? [Lancet HIV. 2015]
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Phase 3, open-label, randomized study of the
pharmacokinetics, efficacy and safety of ixekizumab following
subcutaneous administration using a prefilled syringe or an
autoinjector in patients with moderate-to-severe plaque psoriasis
(UNCOVER-A)
__________________________________________________________________

Open Access Article Link
http://onlinelibrary.wiley.com/doi/10.1111/jdv.13768/abstract

J Eur Acad Dermatol Venereol. 2016 Aug 8.
Phase 3, open-label, randomized study of the pharmacokinetics, efficacy
and safety of ixekizumab following subcutaneous administration using a
prefilled syringe or an autoinjector in patients with moderate-to-severe
plaque psoriasis (UNCOVER-A).

Callis Duffin K1, Bagel J2, Bukhalo M3, Mercado Clement IJ4, Choi SL4,
Zhao F5, Gill A5, Pangallo B5, Shuler C5, Mallbris L5, Jackson K6.

1Department of Dermatology, University of Utah, Salt Lake City, UT, USA.
2Psoriasis Treatment Center of Central New Jersey, Windsor, NJ, USA.
3Altman Dermatology Associates, Arlington Heights, IL, USA.
4Lilly-NUS Centre for Clinical Pharmacology, Singapore City, Singapore.
5Eli Lilly and Company, Indianapolis, IN, USA.
6Eli Lilly and Company, Windlesham, UK.

BACKGROUND: The efficacy of ixekizumab, an anti-interleukin-17A (anti-
IL-17A) monoclonal IgG4 antibody, was demonstrated in moderate-to-severe
psoriasis patients when administered via prefilled syringe (PFS).

OBJECTIVE: To evaluate the effect of two drug delivery devices on the
pharmacokinetics (PK) of ixekizumab as well as efficacy and safety with
both devices.

METHODS: In the first 12 weeks of an open-label, phase 3 study, moderate-
to-severe psoriasis patients were randomized to ixekizumab delivery via
PFS or autoinjector device. Randomization was stratified by weight (<80
kg, 80-100 kg, >100 kg), injection assistance (yes/no) and injection site
(arm, thigh or abdomen). Following a 160-mg initial dose at week 0,
patients received subcutaneous 80-mg ixekizumab as a single injection
every 2 weeks for 12 weeks. Blood samples were collected following the
initial 160-mg dose on days 2, 4, 7, 10 and 14 for PK analysis. Primary PK
parameters were maximum concentration (Cmax ) and area under the curve
(AUC0-tlast ) where tlast is the time of last sample (14 days ± 24 h).
Efficacy was assessed by percent improvement on the Psoriasis Area and
Severity Index (PASI) at week 12. Adverse event reporting, vital signs and
clinical laboratory data were used to evaluate safety.

RESULTS: Of 204 randomized patients, 192 were included in the PK analysis
(PFS: 94; autoinjector: 98). The PFS and autoinjector showed similar
geometric mean Cmax (90% CI) [15.0 µg/mL (13.9-16.1) vs. 14.8 µg/mL
(13.8-15.9)] and geometric mean AUC0-tlast (90% CI) [157 µg × day/mL
(147-168) vs. 154 µg × day/mL (144-165)]. When comparing Cmax and AUC0-
tlast of the autoinjector to PFS, the geometric LS mean ratios were 0.97.
At week 12, mean percent PASI improvement (via modified baseline
observation carried forward) was similar with the PFS (89.3%) and
autoinjector (86.9%). Both devices had safety results that were consistent
with the known safety profile of ixekizumab.

CONCLUSION: The PK, efficacy and safety of ixekizumab administered
subcutaneously by PFS and autoinjector were similar. Clinicaltrials.gov
number: NCT01777191 https://clinicaltrials.gov/ct2/show/NCT01777191.

© 2016 The Authors. Journal of European Academy of Dermatology and
Venereology published by John Wiley & Sons Ltd on behalf of European
Academy of Dermatology and Venereology.

Open Access Article Link
http://onlinelibrary.wiley.com/doi/10.1111/jdv.13768/abstract
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Cosmetic Fillers: Perspectives on the Industry
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26505538

Facial Plast Surg Clin North Am. 2015 Nov;23(4):417-21.
Cosmetic Fillers: Perspectives on the Industry.

Basta SL1.

1590 Berkeley Avenue, Menlo Park, CA 94025, USA. Electronic address:
sbasta100@gmail.com.

The cosmetic filler industry has evolved substantially over the last 30
years. The market is characterized by multiple fillers and a competitive
dynamic among major aesthetics companies.

Marketing in the United States and Europe has been different owing to
regulatory constraints. Differences have led to more rapid growth in the
European market. The US market has evolved owing to growth of major
companies with multiple product portfolios and leverage in consumer
promotion and aesthetics office marketing owing to scale.

The evolution of the filler market will include new materials, injection
techniques, and facilitation devices, and new areas of injection.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS: Cosmetic filler; Dermal filler; Filler market; Industry;
Injectables market
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Hyaluronic acid injection via a pneumatic microjet device to
improve forehead wrinkles
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27503619

J Eur Acad Dermatol Venereol. 2016 Aug 9.
Hyaluronic acid injection via a pneumatic microjet device to improve
forehead wrinkles.

Choi SY1,2, Seok J1, Kwon HJ1, Kwon TR1, Kim BJ1.

1Department of Dermatology, Chung-Ang University College of Medicine,
Seoul, Korea.
2Department of Dermatology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea.

Among the non-surgical treatment modalities, injection of hyaluronic acid
(HA) filler has become the popular cosmetic procedure for reducing
wrinkles.1 The forehead wrinkles require larger volumes of HA filler than
other areas of the face.

In this randomized, placebo-controlled, clinical trial, we investigated
the efficacy and safety of a pneumatic microjet device (Innojector™ ;
Amore Pacific, Seoul, Korea) that delivers hyaluronic acid (HA),
(Restylene Skinboosters® ; Q-Medical, Uppsala, Sweden) into the dermis via
pneumatic needleless or multi-needle injection in order to improve
forehead wrinkles.

This article is protected by copyright. All rights reserved.

KEYWORDS: hyaluronic acid; pneumatic microjet; wrinkle
__________________________________________________________________
________________________________*_________________________________

11. No Abstract: Awareness and practices regarding biomedical waste
management among health-care workers in a tertiary care hospital in
Delhi: Comment
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27514971

Indian J Med Microbiol. 2016 Jul-Sep;34(3):391-2.
Awareness and practices regarding biomedical waste management among
health-care workers in a tertiary care hospital in Delhi: Comment.

David JJ1, Shanbag P2.

1Department of Pediatrics, Seth GS Medical College and KEM Hospital,
Parel, Mumbai, Maharashtra, India.
2Department of Pediatrics, ESI PGIMSR and MGM Hospital, Parel, Mumbai,
Maharashtra, India.
__________________________________________________________________
________________________________*_________________________________

12. News

– India: An Egyptian lesson in India’s fight against growing Hepatitis

– Pakistan: Alarming Situation: Congo virus claims another life in Multan

– Global Needlestick Safety Injection Devices Market 2016- Medtronic, BD,
Smiths Group, West Pharmaceuticals

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________

https://tinyurl.com/hl22h3d
India: An Egyptian lesson in India’s fight against growing Hepatitis

While no official data exists, WHO believes that nearly 40 million people
have Hepatitis B and six million have Hepatitis C in India.

by Tabassum Barnagarwala, The Indian Express, India (16.08.16)

[Photo: Hepatitis is a viral disease that affects liver functioning and
can also turn chronic, leading to fatality.]

In 2006, when Egypt formed a national committee to control the spread of
Hepatitis, the country was known to have the highest burden of the disease
globally. India, at the time, had still not acknowledged its growing
Hepatitis numbers, while focusing on HIV and Tuberculosis.

Over the past decade, Egypt has come a long way, reducing Hepatitis
prevalence from 4.5 per cent then to 1 per cent now, and, in the process,
has provided a roadmap for the World Health Organisation (WHO) and
countries like India, which is grappling with an estimated 6 million
Hepatitis C (HCV) and 40 million Hepatitis B (HBV) cases.

“The syringe culture is similar in Egypt and India. People take less oral
medication and prefer injections. Syringe safety is necessary to prevent
new cases,” says Manal El Sayed, a member of the Egyptian national
hepatitis committee since its inception in 2006. She says her country
raised awareness on the use of sterile razors in barber shops, use of new
instruments for pedicure and manicure and on the use of disposable
syringes for patients. “It’s all about advocacy. There should be multiple
stakeholders like the government, politicians, the media and individuals
from different sectors who wish to bring this health problem into the
limelight,” Sayed, a paediatrician, explains.

The Egyptian government, she says, also urged Hepatitis drug manufacturing
companies to lower costs. Direct cost of hepatitis treatment there was
estimated at $ 670 million and the country was able to treat its patients,
Sayed says, at 1/10 the global price of the drugs. “We decided to treat at
least 30,000- 40,000 patients a year, but there ended up being 65,000
patients. Companies were willing to lower costs,” Sayed says.

The Hepatitis pool grew in Egypt in the 1950s and 1960s due to the reuse
of glass syringes after boiling. It is believed that similar unsafe
syringe practices have led to the increased cases in India. According to
Razia Pendse, South East Regional adviser to WHO, India accounts for 60
per cent of Hepatitis cases in South East Asia. But the country has not
conducted a single survey to determine its Hepatitis load. Egypt, on other
hand, carried out its first survey in 1996 and its latest in 2015.

Egypt has now introduced a birth-dose policy to prevent new infections.
“Our aim is to reach most isolated and rural areas,” Sayed says. The
prevalence of HCV in Egyptian children has dropped to 0.8 percent from the
1.5 percent a decade ago. India, Sayed believes, needs a similar approach.

The Union Ministry of Health and Family Welfare has begun a vaccination
drive for newborns against HBV under Mission Indradhanush, that is aimed
to prevent seven diseases in infants. Since 2014, over 40 lakh children
have been covered under the scheme. But there still stands no active
diagnosis or free treatment programme for Hepatitis adult patients unlike
AIDS or Tuberculosis.

The Health ministry has also roped in Bollywood actor Amitabh Bachchan to
become the face of the campaign. Although delayed, the government is
slowly moving towards disposable syringes with Maharashtra becoming one of
first states to embrace one-time usable syringes. “The cost will be high
but we are looking at local syringe manufacturers,” Maharashtra’s
principal health secretary Sujata Saunik said.

A national survey, under the aegis of the health ministry and WHO, is also
scheduled to kick off in Punjab on the impact of disposable syringe usage.
India has also joined WHO’s Global Campaign for Safe Injection Practice.

WHO’s Dr Henk Bekedam says that for India, the initial cost of the
Hepatitis programme will be high due to high prevalence: “But what is the
cost of a human life? The cost will come down once enough awareness is
created.” He advocates a system to track down infected blood donors from
mass blood donation camps, who, he adds, should then be brought in for
treatment.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/h3bf92z
Pakistan: Alarming Situation: Congo virus claims another life in Multan

By: Shoaib Rajaon, Channel24, Lahore Pakistan (13.08.16)

MULTAN: (News Desk) Another Congo virus patient has died in Multan Nishtar
Hospital on Saturday. According to details, patient Saidullah was admitted
in the hospital few days ago in suspicion of Congo virus.

He was admitted in special ward for treatment while today doctors have
confirmed his death.

Preventive measures against Congo virus

Health experts advised the citizens to take special preventive measures to
protect from carrying Crimean Congo hemorrhagic fever (CCHF).

According to them, healthcare workers caring for patients with suspected
or confirmed Congo virus, or handling specimens from them, should
implement standard infection control precautions.

These include basic hand hygiene, use of personal protective equipment,
safe injection practices and safe burial practices

Dr Wasim Khawaja, a public health specialist at Pakistan Institute of
Medical Sciences (PIMS), said reducing the risk of tick-to-human
transmission people should wear protective clothing like long sleeves or
long trousers and wear light coloured clothing to allow easy detection of
ticks on the clothes.

He said people should use approved chemicals intended to kill ticks on
clothing, use approved repellent on the skin and clothing, regularly
examine clothing and skin for ticks, if found, remove them and avoid
areas where ticks are abundant and seasons when they are most active.

Dr Khawaja said in order to reducing the risk of animal-to-human
transmission people should wear gloves and other protective clothing while
handling animals or their tissues in endemic areas, notably during
slaughtering, butchering and culling procedures in slaughterhouses or at
home.

He added to reduce the risk of human-to-human transmission in the
community, people should avoid close physical contact with CCHF-infected
people, wear gloves and protective equipment when taking care of ill
people and wash hands regularly after caring for or visiting ill people.

Medical practitioner at Federal Government Poly Clinic (FGPC)

Dr Sharif Astori said the virus is primarily transmitted to people from
ticks and livestock animals.

**** He added human-to-human transmission can occur resulting from close
contact with the blood, secretions, organs or other bodily fluids of
infected persons.

He said CCHF is a widespread disease caused by a tick-borne virus. The
hosts of the CCHF virus included a wide range of wild and domestic animals
such as cattle, sheep and goats.

He said animals become infected by the bite of infected ticks and the
virus remains in their bloodstream for about one week after infection,
allowing the tick-animal-tick cycle to continue when another tick bites.

The CCHF virus is transmitted to people either by tick bites or through
contact with infected animal blood or tissues during and immediately after
slaughter, he added.

He said majority of cases have occurred in people involved in the
livestock industry, such as agricultural workers, slaughterhouse workers
and veterinarians.

He said human-to-human transmission can occur resulting from close contact
with the blood, secretions, organs or other bodily fluids of infected
persons.

**** Hospital-acquired infections can also occur due to improper
sterilization of medical equipment, reuse of needles and contamination of
medical supplies, he added.

He said following infection by a tick bite, the incubation period is
usually one to three days, with a maximum of nine days.

The incubation period following contact with infected blood or tissues is
usually five to six days, with symptoms included fever, muscle ache,
dizziness, neck pain and stiffness, backache, headache, sore eyes and
photophobia (sensitivity to light).

He said there may be nausea, vomiting, diarrhoea, abdominal pain and sore
throat early on, followed by sharp mood swings and confusion. After two to
four days, the agitation may be replaced by sleepiness, depression and
lassitude, and the abdominal pain may localize to the upper right
quadrant, with detectable hepatomegaly (liver enlargement).

He said other clinical signs included fast heart rate), enlarged lymph
nodes, and a rash caused by bleeding into the skin on internal mucosal
surfaces, such as in the mouth and throat, and on the skin.

Dr Astori said there is usually evidence of hepatitis, and severely ill
patients may experience rapid kidney deterioration, sudden liver failure
or pulmonary failure after the fifth day of illness.

The mortality rate from CCHF is approximately 30%, with death occurring in
the second week of illness. In patients who recover, improvement generally
begins on the ninth or tenth day after the onset of illness.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zjqtatg
Global Needlestick Safety Injection Devices Market 2016- Medtronic, BD,
Smiths Group, West Pharmaceuticals.

By James Johnson, cHollywood News Portal (press release) (05.08.16)

Global Needlestick Safety Injection Devices Market 2016 Market.Biz has
recently launched new Market Research Report on “Needlestick Safety
Injection Devices Market” is a in-depth and professional survey on
Needlestick Safety Injection Devices Market.

The research study Global Needlestick Safety Injection Devices Industry
offers strategic assessment of the Global Needlestick Safety Injection
Devices market. The industry report focuses on the growth opportunities,
which will help the Global Needlestick Safety Injection Devices industry
to expand operations in the existing markets.

The players list (Partly, Players you are interested in can also be added)

1. Medtronic
2. BD
3. Smiths Group
4. West Pharmaceuticals
5. Terumo
6. Unilife
7. Catalent
8. Beipu
9. Revolutions Medical
10. Retractable Technologies
11. Duopross Meditech

With no less than 15 top producers.

Do Inquiry Before Purchasing Report Here: https://tinyurl.com/hnw2xtc or
https://market.biz/report/global-needlestick-safety-injection-devices-mark
et-2016-industry-research-report/11240/#inquiry

The study assess new product and service positioning strategies in the
Global Needlestick Safety Injection Devices market. Furthermore, the new
and evolving technologies and their impact on the Needlestick Safety
Injection Devices market is analyzed in detail in this report.

After that, Needlestick Safety Injection Devices industry development
policies as well as plans are discussed and manufacturing processes as
well as cost structures for Needlestick Safety Injection Devices market.
This report “Worldwide Needlestick Safety Injection Devices Market” also
states import/export, supply and consumption figures and Needlestick
Safety Injection Devices market cost, price, revenue and Needlestick
Safety Injection Devices market’s gross margin by regions (North America,
Europe, Japan, China, Southeast Asia, India), as well as other regions can
be added in Needlestick Safety Injection Devices Market area.

The leading players in the Global Needlestick Safety Injection Devices
market have been profiled in this report. The key Needlestick Safety
Injection Devices market players with their business overview, marketing
strategies, strategic alliances and acquisitions are included in this
Needlestick Safety Injection Devices market report.

The report (Worldwide Needlestick Safety Injection Devices Market)
features significant industry insights, Needlestick Safety Injection
Devices market expectations, and key developments, which will help firms
operating in the Needlestick Safety Injection Devices market to make
informed business decisions.

Detailed business overview, Needlestick Safety Injection Devices market
revenue analysis, strategies, and SWOT analysis of the key players has
been included in the report. Players in the Global Needlestick Safety
Injection Devices market are aiming to expand their operations to emerging
regions. Further, companies in the Needlestick Safety Injection Devices
market are focusing on innovation and positioning their products at
competitive prices. An in-depth Needlestick Safety Injection Devices
supply chain analysis in the report will give readers a better
understanding of the Needlestick Safety Injection Devices market.

The report also delivers a detailed segment-based assessment of the Global
Needlestick Safety Injection Devices market. The segments along with their
sub-segments have been analyzed in this report. Furthermore, the report
(Worldwide Needlestick Safety Injection Devices Industry) evaluates the
trends that will help to fuel the growth of the individual sectors. The
key segments of the Global Needlestick Safety Injection Devices market
along with their market forecasts both in terms of revenue and volume have
been covered in the Needlestick Safety Injection Devices market research
study. The worldwide Needlestick Safety Injection Devices market report
also talks about the emerging geographical sectors in Needlestick Safety
Injection Devices market and the trends that will drive the industry
across these regional segments.
__________________________________________________________________
________________________________*_________________________________
New WHO Injection Safety Guidelines

WHO is urging countries to transition, by 2020, to the exclusive use of
the new “smart” syringes, except in a few circumstances in which a syringe
that blocks after a single use would interfere with the procedure.

The new guideline is:

WHO Guideline on the use of Safety-Engineered Syringes for Intramuscular,
Intradermal and Subcutaneous Injections in Health Care

It is available for free download or viewing at this link:
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf

PDF Requires Adobe Acrobat Reader [620 KB]
__________________________________________________________________
________________________________*_________________________________
Making all injections safe brochure

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting 2015

The Safe Injection Global Network SIGN meeting was held on 23-24 February
2015 at WHO Headquarters in Geneva Switzerland

The main topic of the meeting was the new injection safety policy
recommendation and developing the appropriate strategies for
implementation in countries worldwide.

A report of the meeting will be posted ASAP
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2 get
SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

* Subscribe or unsubscribe by email: signmoderator@googlegroups.com

The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
reports, field reports, documents, images such as photographs, posters,
signs and symbols, and video.
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Service Delivery and Safety (SDS) Health
Systems and Innovation (HIS) at WHO HQ, Geneva Switzerland.

The SIGN Forum is moderated by Allan Bass and is hosted on GoogleGroups

Subscribe or unsubscribe by email: signmoderator@googlegroups.com
__________________________________________________________________
________________________________*_________________________________
__________________________________________________________________

Comments are closed.