Sexualised drug use among gay and bisexual men in New Zealand: Findings from a national cross-sectional study.

INTRODUCTION: New Zealand has a unique illicit drug market, gay cultures and drug use patterns. Minimal attention has been given to how drug use shapes sexual practice, especially in the era of biomedical HIV prevention among gay and bisexual men (GBM). METHODS: An online cross-sectional study of GBM ('Flux NZ') adapted from an Australian study was undertaken to explore connections between drug use, sexual practice, health and community. We describe drug use patterns, then identify three discrete groups determined by intensity of recent (past 6 months) sexual practice: no recent sex, recent sex and recent sexualised drug use. We examine factors associated with these groups and identify factors independently predicting sexualised drug use. RESULTS: Of 739 participants, almost a third had engaged in group sex (29%), 17.5% were taking pre-exposure prophylaxis (PrEP), 6.5% were HIV positive. Overall, 59.5% had recently used illicit drugs (16.9% methylenedioxymethamphetamine, 6% methamphetamine, 3.3% gamma-hydroxybutyrate acid, 1.4% ketamine). Sexualised drug use was common (35.7%). Those engaged in sexualised drug use were connected to gay community and had a high uptake of biomedical HIV prevention. Independent predictors of sexualised drug use included being sexually adventurous, knowing their HIV status, having more than 10 recent sexual partners, engaging in group sex and sex at a sex-on-site venue. DISCUSSION AND CONCLUSIONS: Many GBM engaging in sexualised drug use manage HIV transmission risks through regular testing, PrEP and HIV treatment. HIV prevention efforts should target GBM with less intensive sexual behaviour but who may be at comparatively higher risk of HIV transmission.

Reproductive ecology of muskellunge (Esox masquinongy), an introduced predator, in the lower Wolastoq/Saint John River, New Brunswick, Canada.

Introduced predators can have harmful top-down effects on their newly colonized system through competition with and direct predation on native species. Following an initial introduction of muskellunge in Lac Frontière, Québec in the 1970s at the headwaters of the Wolastoq/Saint John River, the species rapidly migrated downstream, expanding its range by ~500 km over ~20 years. Despite this expansive colonization and concern over possible threats to native species, little is known about the basic ecology of muskellunge in this system. The last downstream barrier is the hydroelectric facility, Mactaquac Generating Station (MGS), 150 km upstream of the sea. While there are no downstream fish passage facilities at MGS, adult muskellunge have been recorded downstream. In this study, muskellunge (n = 23) were surgically tagged with very-high-frequency (VHF) radio or combined acoustic radio telemetry (CART) tags and tracked over two spawning seasons. We sought to determine if there was a reproducing population downstream of MGS and tracked Tagged muskellunge over two spawning seasons. We tracked fish to locate and confirm spawning sites, and followed up with egg and/or juvenile sampling surveys. Tagged muskellunge (90%) moved upstream towards the MGS during the spawning period in each year (2016 and 2017), where they remained throughout the entire spawning period. No spawning or nursery sites were confirmed near MGS, but in 2016 three distinct spawning locations and six distinct nursery sites were confirmed 10-12 km downstream amongst a chain of flooded islands. In 2016, eggs, sac-fry and juveniles were collected and confirmed as muskellunge by genetic sequencing, providing the first empirical observation of successful spawning downstream of MGS.

Genomic population structure of Striped Bass (Morone saxatilis) from the Gulf of St. Lawrence to Cape Fear River.

Striped Bass, Morone saxatilis (Walbaum, 1792), is an anadromous fish species that supports fisheries throughout North America and is native to the North American Atlantic Coast. Due to long coastal migrations that span multiple jurisdictions, a detailed understanding of population genomics is required to untangle demographic patterns, understand local adaptation, and characterize population movements. This study used 1,256 single nucleotide polymorphism (SNP) loci to investigate genetic structure of 477 Striped Bass sampled from 15 locations spanning the North American Atlantic coast from the Gulf of St. Lawrence, Canada, to the Cape Fear River, United States. We found striking differences in neutral divergence among Canadian sites, which were isolated from each other and US populations, compared with US populations that were much less isolated. Our SNP dataset was able to assign 99% of Striped Bass back to six reporting groups, a 39% improvement over previous genetic markers. Using this method, we found (a) evidence of admixture within Saint John River, indicating that migrants from the United States and from Shubenacadie River occasionally spawn in the Saint John River; (b) Striped Bass collected in the Mira River, Cape Breton, Canada, were found to be of both Miramichi River and US origin; (c) juveniles in the newly restored Kennebec River population had small and nonsignificant differences from the Hudson River; and (d) tributaries within the Chesapeake Bay showed a mixture of homogeny and small differences among each other. This study introduces new hypotheses about the dynamic zoogeography of Striped Bass at its northern range and has important implications for the local and international management of this species.

Identifying risk factors for severe hypoglycemia in hospitalized patients with diabetes.

OBJECTIVE: Some of the deleterious effects of hypoglycemia in hospitalized patients include increased rates of mortality and longer length of stay. Our primary objective was to identify the risk factors associated with severe hypoglycemia to identify those patients at highest risk. METHODS: The medical records of 5,026 patients with diabetes mellitus (DM) admitted in 2010 were reviewed to identify those patients that developed severe hypoglycemia (blood glucose [BG] <40 mg/dL). We performed χ2 tests to assess statistical significance. Adjusted logical regression was used to determine the risk factors for hypoglycemia in the hospital. RESULTS: Out of 5,026 DM patients included in our review, 81 experienced severe hypoglycemia (1.6%). Statistically higher proportions of chronic kidney disease (CKD; 69.1% vs. 46.9%, P<.001), congestive heart failure (CHF; 48.1% vs. 28.5%, P<.001), sepsis (49.4% vs. 12.5%, P<.001), insulin use (45.7% vs. 26.04%, P = .000), type 1 DM (21% vs. 5.1%, P = .000), and cirrhosis (14.8% vs. 7.2%, P = .009) were seen in the severe hypoglycemic group compared to the nonsevere hypoglycemic group. Overall, 84% of patients who experienced an episode of severe hypoglycemia in the hospital (BG <40 mg/dL) had a previous episode of hypoglycemia (BG <70 mg/dL). The odds ratios (ORs) for type 1 DM, sepsis, previous hypoglycemia, and insulin use were 3.43 (95% confidence interval [CI] 1.81, 6.49), 2.64 (95% CI 1.6, 4.35), 46.1 (95% CI 24.76, 85.74), and 1.66 (95% CI 1.02, 2.69), respectively. CONCLUSION: Prior episodes of hypoglycemia in the hospital, the presence of type 1 DM, insulin use, and sepsis were identified as independent risk factors for the development of severe hypoglycemia in the hospital.

Angiosarcoma following MammoSite partial breast irradiation.

Angiosarcoma is a rare tumor of endothelial origin which commonly arises in small blood or lymphatic vessels. Its development in the treated breast following adjuvant external beam radiation is also rare. To our knowledge, there are no reported cases in the literature or MammoSite registry which describe the occurrence of angiosarcoma in the treated breast following MammoSite brachytherapy. This is a case report of a 74 year old female who developed angiosarcoma 4 years after receiving MammoSite balloon brachytherapy following surgical resection of a T1mic N0 M0 infiltrating ductal carcinoma.

Coenzyme q10 and statin-induced mitochondrial dysfunction.

Coenzyme Q10 is an important factor in mitochondrial respiration. Primary and secondary deficiencies of coenzyme Q10 result in a number of neurologic and myopathic syndromes. Hydroxyl-methylglutaryl coenzyme A reductase inhibitors or statins interfere with the production of mevalonic acid, which is a precursor in the synthesis of coenzyme Q10. The statin medications routinely result in lower coenzyme Q10 levels in the serum. Some studies have also shown reduction of coenzyme Q10 in muscle tissue. Such coenzyme Q10 deficiency may be one mechanism for statin-induced myopathies. However, coenzyme Q10 supplements have not been shown to routinely improve muscle function. Additional research in this area is warranted and discussed in this review.

The epidemic of vitamin D deficiency.

A 37-year-old woman was referred to our endocrine clinic for management of her long-standing hypothyroidism. Her main complaints were muscle aches and pains that started about a year ago. The symptoms progressed to generalized muscle weakness. She described difficulty in getting out of her chair and in climbing stairs. She had an extensive work-up done by her neurologist and rheumatologist, including nerve-conduction studies and a muscle biopsy. The evaluation was normal, and she was diagnosed with fibromyalgia. She had gastric bypass surgery in 1998 and lost 150 pounds since the operation. She also has had lactose intolerance and a compression fracture without trauma. Her weight was 314 pounds. She had proximal muscle weakness. The rest of her physical examination was normal. Serum laboratory values are listed in Table 1. Based on the laboratory values, she was diagnosed as having severe vitamin D deficiency. She was started on 50,000 IU of vitamin D2 (Ergocalciferol) once a week for 6 months. Now her 25 hydroxyvitamin D level is 40 ng/mL, and her muscle strength has improved.