Drogas de abuso asociadas a las intoxicaciones agudas: descripción global y análisis de las diferencias en mujeres atendidas en el servicio de urgencias / Street drugs associated with acute poisoning: description and analysis of differences in women attended in a hospital emergency department

Objetivos. La prevalencia del uso de drogas de abuso es difícil de establecer en mujeres, debido a los estigmas asociados a ello. El objetivo principal fue analizar las posibles diferencias de las intoxicaciones agudas (IA) según el sexo en una muestra de pacientes atendidos en dos servicios de urgencias hospitalarios (SUH). El objetivo secundario fue identificar las variables asociadas a las intoxicaciones graves, definidas de forma arbitraria como las que requerían una atención intensiva médica de más de 12 horas y posterior ingreso hospitalario. Métodos. Estudio retrospectivo en dos SUH que incluyeron pacientes mayores de 18 años atendidos por IA por drogas de abuso, en el periodo comprendido entre el 1 de julio 2020 y el 31 de julio 2023. Se recogieron variables epidemiológicas, clínicas y de laboratorio. Resultados. Se incluyeron 1.032 pacientes, un 18,5% (191) mujeres. La edad media fue de 35 (DE 10) años, con elevada prevalencia de enfermedad mental aguda (32,2%) e infección por VIH (35,7%). El principal motivo de consumo fue lúdico (90,9%). Las principales drogas de abuso fueron cocaína, alcohol y metanfetaminas. El análisis multivariado mostró que únicamente la edad (OR: 1,03, IC 95%: 1,01-1,05, p = 0,003), el VIH (OR: 2,10, IC 95%: 1,29-3,41, p = 0,003), el consumo de benzodiacepinas (OR: 3,48, IC 95%: 2,14-5,66, p < 0,0001), y la ideación autolítica (OR: 1,82, IC 95%: 1,25-3,79, p = 0,004), se asociaron a gravedad de la intoxicación. Conclusiones. Las IA por drogas de abuso en mujeres presentan algunas diferencias en relación a las de los hombres, ya que son más jóvenes y asocian consumo de alcohol con mayor frecuencia. Las campañas de prevención y políticas sanitarias sobre el uso de sustancias deberían tener en cuenta las diferencias en el consumo según el sexo para adaptarlas a la población a las que vayan dirigidas. (AU)

Background. The prevalence of street drug abuse is difficult to establish in women because of stigma associated withthe practice. The main objective of this study was to analyze possible differences between men and women in a sample of patients attended for emergencies due to acute poisonings. The secondary aim was to identify variables associated with severe poisonings defined arbitrarily as requiring intensive care for more than 12 hours after hospital admission. Methods. Retrospective study in 2 hospital EDs. We included patients over the age of 18 years attended for street drug poisonings between July 1, 2020, and July 31, 2023. Epidemiologic, clinical, and laboratory variables were analyzed. Results. A total of 1032 patients were studied; 191 (18.5%) were women. The mean (SD) age was 35 years, and the prevalences of acute mental illness and HIV infection were high at 32.2% and 35.7%, respectively. Drug use was recreational in most cases (90.9%). Cocaine, alcohol, and methamphetamines were the substances most often used. Multivariate analysis showed that the factors associated with the seriousness of poisoning were age, with an odds ratio (OR) of 1.03 (95% CI, 1.01-1.05; P = .003); HIV (OR, 2.10; 95% CI, 1.29-3.41; P = .003); use of benzodiazepines (OR, 3.48; 95% CI, 2.14-5.66; P < .0001); and suicidal ideations (OR, 1.82; 95% CI, 1.25-3.79; P = .004). Conclusions. Differences in poisoning characteristics in women were found, probably related to the younger ages of men in the sample and their higher frequency of alcohol consumption. Public health policies and campaigns to prevent drug abuse should take gender differences into consideration in order to adapt messages to the target populations. (AU)

SmartAnalysis: A sustainable digital-image colorimetry method for ethanol determination in alcohol-based hand sanitizer / SmartAnalysis: Un método sostenible de colorimetría de imagen digital para la determinación de etanol en desinfectante de manos a base de alcohol

Introducción: El consumo de desinfectantes de manos a base de alcohol ha aumentado significativamente después de la pandemia causada por el SARS-CoV-2. A pesar de la conclusión de la emergencia sanitaria declarada por la OMS en 2023, la costumbre de desinfectar las manos con geles sanitizantes a base de etanol ha sido adoptada a nivel mundial por la población. Dado que los métodos generales descritos en los compendios oficiales para la de-terminación del etanol, como la cromatografía de gases o la destilación, son laboriosos y no específicos para geles que contienen carbómero, este trabajo propone un método alternativo basado em la colorimetría de imágenes digitales. Método: La imagen digital (proporcionada por la reacción etanol-fenolftaleína) fue capturada y transformada en una señal analítica basada en el sistema de colores Rojo-Verde-Azul. Las adquisiciones de imágenes se realizaron utilizando un smartphone Samsung Galaxy J6, y las señales se generaron mediante el programa gratuito Photometrix Pro®. El método fue validado de acuerdo con las directrices de la ICH y se aplicó en muestras comerciales. Además, el método propuesto fue evaluado por su impacto ambiental utilizando la herramienta Índice del Proceso Analítico Verde (GAPI). Se generaron pictogramas utilizando el programa gratuito ComplexGAPI®.Resultados: El canal verde mostró una respuesta lineal en las curvas de calibración para concentraciones de etanol que van desde el 5 hasta el 40 % (p/p) en medio ácido. El método demostró linearidad, precisión, exactitud y robustez. Conclusiones: El método propuesto presentó como principales ventajas el uso de dispositivos de bajo costo y fáciles de manejar, así como un consumo reducido de reactivos, de acuerdo con los principios de la química analítica verde. (AU)

Introduction: The consumption of alcohol-based hand sanitizers has increased significantly after the pandemic caused by SARS-CoV-2. Despite the conclusion of the health emergency declared by the WHO in 2023, the habit of sanitizing hands with ethanol-based gel sanitizers has been globally adopted by the population. Since general methods described in official compendia for ethanol determination such as gas chromatography or distillation are laborious and not-specific to carbomer-containing gels, this work proposes an alternative method based on digital image colorimetry. Method: The digital image (provided by ethanol-phenolphthalein reaction) was captured and transformed into an analytical signal based on the Red-Green-Blue system. The image acquisitions were performed using a Samsung Galaxy J6 smartphone, and the signals were generated using the Photometrix Pro® free program. The method was validated in accordance with ICH and applied in commercial samples. Additionally, the proposed method was eval-uated for its environmental impact using the Green Analytical Process Index (GAPI) tool. Pictograms were generated using the ComplexGAPI® free program. Results: Green channel exhibited a linear response in the calibration curves for ethanol concentrations ranging from 5 to 40 % (w/w) in acidic medium. The method showed linearity, precision, accuracy, and robustness. Conclusions: The proposed method presented as main advantages the use of low-cost and easy-to-handle devices and reduced reagent consumption, in accordance with green analytical chemistry principles. (AU)

Effect of Coturnix japonica (quail) egg yolk in ethanol damage-induced mice

Introduction: The high prevalence of neurodegenerativediseases in the older adult population requires research fo-cused on functional foods with regulatory properties on redoxstate and with antioxidant potential. Quail egg yolk is a foodwith a great diversity of antioxidant compounds with neuro-protective activity. Objective: To evaluate the effect of Coturnix japonica eggyolk administration on the nervous tissue of mice againstethanol damage induction. Methodology: 35 mice received the following treatmentvia orogastric for five days: groups I and II water (10 mL/kg),group III egg yolk (5 mL/kg), group IV egg yolk (10 mL/kg)and group V egg yolk (15 mL/kg). On the fifth day, 99%ethanol was administered subcutaneously (5 g/kg) to groupsII-V. After four hours, the mice were decapitated to obtain thebrain and cerebellum and subsequently perform biochemicaltests and histopathological analysis. Results: Group IV presented neuronal proliferation phe-nomenon and Purkinje cells pluristratification in the brain andcerebellum respectively and additionally presented a betterGSH/GSSG ratio (p<0.05) in comparison to group II. Therewas no statistically significant difference between proteinlevels or protein sulfhydryl groups in any of the groups. Conclusions:Coturnix japonica egg yolk administrationresulted in better preservation of the brain and cerebellum’scytoarchitecture and increased GSH profile (AU)

Use of Dicranum polysetum extract against Paenibacillus larvae causing American Foulbrood under in vivo and in vitro conditions / Uso del extracto de Dicranum polysetum contra larvas de Paenibacillus causantes de la loque americana en condiciones in vivo e in vitro

Recent research shows that Dicranum species can be used to ameliorate the negative effects of honeybee bacterial diseases and that novel compounds isolated from these species may have the potential to treat bacterial diseases. This study aimed to investigate the efficacy of Dicranum polysetum Sw. against American Foulbrood using toxicity and larval model. The effectiveness of D. polysetum Sw. ethanol extract in combating AFB was investigated in vitro and in vivo. This study is important in finding an alternative treatment or prophylactic method to prevent American Foulbrood disease in honey bee colonies. Spore and vegetative forms of Paenibacillus larvae PB31B with ethanol extract of D. polysetum were tested on 2040 honey bee larvae under controlled conditions. Total phenolic and flavonoid contents of D. polysetum ethanol extracts were determined as 80.72 mg/GAE(Gallic acid equivalent) and 303.20 µg/mL, respectively. DPPH(2,2-diphenyl-1-picrylhydrazyl) radical scavenging percent inhibition value was calculated as 4.32%. In Spodoptera frugiperda (Sf9) and Lymantria dispar (LD652) cell lines, the cytotoxic activities of D. polysetum extract were below 20% at 50 µg/mL. The extract was shown to considerably decrease infection in the larvae, and the infection was clinically halted when the extract was administered during the first 24 h after spore contamination. The fact that the extract contains potent antimicrobial/antioxidant activity does not reduce larval viability and live weight, and does not interact with royal jelly is a promising development, particularly regarding its use to treat early-stage AFB infection.(AU)

Binge drinking leads to an oxidative and metabolic imbalance in skeletal muscle during adolescence in rats: endocrine repercussion

Binge drinking (BD) is an especially pro-oxidant model of alcohol consumption, mainly used by adolescents. It has recently been related to the hepatic IR-process. Skeletal muscle is known to be involved in insulin action and modulation through myokine secretion. However, there is no information on muscle metabolism and myokine secretion after BD exposure in adolescents. Two experimental groups of adolescent rats have been used: control and BD-exposed one. Oxidative balance, energy status and lipid, and protein metabolism have been analyzed in muscle, together with myokine serum levels (IL-6, myostatin, LIF, IL-5, fractalkine, FGF21, irisin, BDNF, FSTL1, apelin, FABP3, osteocrin, osteonectin (SPARC), and oncostatin). In muscle, BD affects the antioxidant enzyme balance leading to lipid and protein oxidation. Besides, it also increases the activation of AMPK and thus contributes to decrease SREBP1 and pmTOR and to increase FOXO3a expressions, promoting lipid and protein degradation. These alterations deeply affect the myokine secretion pattern. This is the first study to examine a general myokine response after exposure to BD. BD not only caused a detrimental imbalance in myokines related to muscle turnover, decreased those contributing to increase IR-process, decreased FST-1 and apelin and their cardioprotective function but also reduced the neuroprotective BDNF. Consequently, BD leads to an important metabolic and energetic disequilibrium in skeletal muscle, which contributes to exacerbate a general IR-process. (AU)

Lactobacillus rhamnosus GG treatment potentiates ethanol-induced behavioral changes through modulation of intestinal epithelium in Danio rerio / El tratamiento con Lactobacillus rhamnosus GG potencia los cambios de comportamiento inducidos por etanol a través de la modulación del epitelio intestinal en Danio rerio

The gut-brain axis directly regulates the brain homeostatic environment; an imbalance in gut microbial composition following ethanol exposure is maleficent. In this context, involvement of probiotics as prophylactic intervention against ethanol-induced neurotoxicity is elusive in the literature. Therefore, the present study was aimed to determine the impact of chronic ethanol exposure on the neurobehavioral response of zebrafish and possible neuroprotection through co-supplementation of probiotic Lactobacillus rhamnosus GG (LGG). Zebrafish were divided into naive, control, ethanol (0.01% v/v), LGG, and ethanol co-supplemented with LGG groups. Neurobehavioral assessment was performed after 7 days of chronic waterborne exposure to ethanol with LGG co-supplementation followed by histopathological studies. The findings indicated that there was a clear alteration in locomotor activity and habitat preference, with animals preferentially migrating toward altered zones on exposure to ethanol. However, co-supplementation of LGG showed restoration against ethanol-induced neurobehavioral and cognitive dysfunction. Brain tissue pyknosis and intestinal epithelial disruption were significantly mitigated on LGG co-supplementation against ethanol in zebrafish. The present study provides a novel approach toward supplementation of probiotics such as LGG in modulation of gut commensal microbiota influencing zebrafish behavior. Moreover, the findings delineate the possible role of probiotics as a curative administration to counter ethanol-persuaded neurological outcomes.(AU)

Urban drinking and driving: comparison of electric scooter and bicycle related accidents in facial fracture patients

Background: In recent years, electric scooters (e-scooter) have emerged as an alternative mode of urban transport due to their availability and effortless use. However, e-scooter-related trauma and injuries, especially to the head, have received wide media coverage and raised public concern about their safety. We aim to determine and compare clinically relevant variables, incidence, and severity between bicycle and e-scooter-related facial fractures and potential protective measures for injury prevention. Material and methods: This retrospective study comprised all patients admitted to a tertiary trauma center with bicycle or e-scooter-related facial fractures between January 2019 and October 2020. Patient- and injury-related variables, including demographics, injury mechanisms, helmet use, influence of alcohol, types of facial injuries, types of other injuries, given treatment, and hospital stay, were collected, analysed, and compared between bicycle and e-scooter injuries. Results: Altogether 169 patients with facial fractures, 124 bicycle-related injuries (73.4%) and 45 e-scooter-related injuries (26.6%) were included. Alcohol involvement was significantly higher in e-scooter patients (88.9%) than in bicycle patients (31.5%) (p<0.001). Driving under the influence of alcohol was associated with driving without a helmet in both groups (p<0.001). In multivariate analyses, e-scooter accidents were 18 times more likely to occur under the influence of alcohol (OR 17.85, p<0.001) and were more likely to involve collision with a stationary object (OR 3.81, p=0.028). E-scooter patients were significantly younger (OR 0.95, p<0.001) and had significantly more cranial fractures (OR 10.15, p=0.014) than bicycle patients. (AU)

Características diferenciales de los pacientes con carcinoma escamoso de cabeza y cuello sin antecedentes de consumo de tabaco ni alcohol / Differential characteristics of patients with squamous cell carcinoma of the head and neck with no history of tobacco or alcohol use

Objetivo: El objetivo del presente estudio es analizar las características diferenciales de los pacientes con un carcinoma escamoso de cabeza y cuello (CECC) sin antecedentes de consumo de tóxicos, como el tabaco y el alcohol.Material y métodosSe llevó a cabo un estudio retrospectivo de 4.694 pacientes con un CECC localizado en la cavidad oral, orofaringe, hipofaringe o laringe tratados en nuestro centro durante el periodo 1985-2019.ResultadoUn 7,7% de los pacientes (n=363) no refirieron el antecedente de consumo de tóxicos. El grupo de pacientes sin antecedentes tóxicos tenía mayor edad, una mayor proporción de mujeres, una mayor frecuencia de casos localizados en la cavidad oral, una mayor proporción de casos diagnosticados en estadios iniciales y una menor incidencia de segundas neoplasias. El porcentaje de pacientes sin antecedentes de consumo de tóxicos aumentó de forma significativa a lo largo del periodo de estudio. La supervivencia global de los pacientes sin antecedentes de consumo de tóxicos fue significativamente más elevada que la de los pacientes con antecedentes tóxicos. La supervivencia específica para los pacientes con tumores localizados en la cavidad oral sin antecedentes tóxicos fue significativamente inferior, en tanto que para los pacientes con carcinomas de orofaringe la ausencia de antecedentes de consumo de tóxicos se asoció a un mejor pronóstico.ConclusionesExistieron diferencias en las características epidemiológicas y pronósticas de los pacientes con CECC en función del antecedente de consumo de tóxicos como el tabaco o el alcohol. (AU)

Objective: The present study aims to analyze the differential characteristics of patients with head and neck squamous cell carcinoma (HNSCC) without a history of consumption of toxic substances such as tobacco and alcohol.Material and methodsWe carried out a retrospective study of 4,694 patients with HNSCC located in the oral cavity, oropharynx, hypopharynx or larynx treated in our center during the period 1985-2019.ResultThe 7.7% of the patients (n=363) did not report a history of consumption of toxic substances. The group of patients with no toxic history was older, had a higher proportion of women, a higher frequency of cases located in the oral cavity, a higher proportion of cases diagnosed in early stages, and a lower incidence of second neoplasms. The percentage of patients with no history of consumption of toxic substances increased significantly over the study period. The overall survival of patients with no history of consumption of toxic substances was significantly higher than that of patients with toxic substances use. Specific survival for patients with tumors located in the oral cavity without a history of consumption of toxic substances was significantly lower than that of patients with toxic substances use, whereas for patients with oropharyngeal carcinomas the absence of a history of consumption of toxic substances was associated with a better prognosis.ConclusionsThere were differences in the epidemiological and prognostic characteristics of patients with HNSCC according to the history of consumption of toxic substances such as tobacco and alcohol. (AU)

In vitro activity of six biocides against carbapenemase-producing Klebsiella pneumoniae and presence of genes encoding efflux pumps / Actividad in vitro de seis biocidas frente a Klebsiella pneumoniae productora de carbapenemasa y presencia de genes codificantes de bombas de expulsión

Introduction: Acquisition of reduced susceptibility to biocides may contribute to the dissemination of high-risk (HR) clones of carbapenemase-producing Klebsiella pneumoniae (CP-Kp). The aim of this study was (a) to determinate the activity of biocides against CP-Kp, and (b) to analyse the relationship between biocide activity and the presence of efflux pumps. Methods: The minimal inhibitory concentrations (MICs) of 6 biocides (sodium hypochlorite, chlorhexidine digluconate, benzalkonium chloride, povidone-iodine, ethanol and triclosan) were determined in triplicate at 25°C and 37°C in Mueller-Hinton broth (MHB) and M9 minimum medium, against 17 CP-Kp isolates representing different clones (HR and no-HR), sequence-types (STs) and carbapenemases. Efflux pumps genes were detected by whole genome sequencing (MiSeq). Results: Median MICs were slightly higher at 37°C than at 25°C (p≤0.05), except for benzalkonium chloride, triclosan and ethanol. MIC medians were much higher in MHB than in M9, except for triclosan. No significant differences were observed in the median MICs, regarding the type of clone, ST or carbapenemase; cepA, acrAB, kpnEF and oqxAB genes were detected in all isolates, whereas qacE and qacA were not detected; smvAR, and qacΔE genes were detected in 94% and 47% of isolates, respectively. Conclusions: Triclosan, chlorhexidine digluconate, benzalkonium chloride and ethanol were the most active biocides. The activity of some biocides is affected by temperature and growth media, suggesting that standardised procedures for biocide susceptibility testing based on MIC determination are required. This activity, in terms of MICs, are not related to the type of clone, ST, carbapenemase or the presence of the efflux pump genes.(AU)

Introducción: La adquisición de sensibilidad reducida a los biocidas puede contribuir a la diseminación de clones de alto riesgo (HR) de Klebsiella pneumoniae productor de carbapenemasa (Kp-PC). El objetivo de este trabajo fue: (a) determinar la actividad de varios biocidas frente a Kp-PC, y (b) analizar la relación de dicha actividad con la presencia de genes codificantes de bombas de expulsión. Métodos: Las concentraciones mínimas inhibitorias (CMI) de 6 biocidas (hipoclorito de sodio, digluconato de clorhexidina, cloruro de benzalconio, povidona yodada, etanol y triclosán) se determinaron por triplicado a 25 y 37°C, tanto en caldo Mueller-Hinton (MHB) como en medio mínimo M9, frente a 17 aislados de Kp-PC representativos de diferentes clones (HR y no HR), secuenciotipos (ST) y carbapenemasas. Los genes de bombas de expulsión se detectaron mediante secuenciación masiva del genoma completo (MiSeq). Resultados: Las medianas de las CMI fueron ligeramente superiores a 37°C que a 25°C, excepto para cloruro de benzalconio, etanol y triclosán. Las medianas de las CMI fueron considerablemente superiores en MHB que en M9, excepto para triclosán; cepA, acrAB, kpnEF y oqxAB se detectaron en todos los aislados, mientras que qacE y qacA no se detectaron; smvAR y qacΔE se detectaron en el 94% y en el 47% de los aislados, respectivamente. Conclusiones: La actividad de algunos biocidas se afecta por la temperatura y el medio de crecimiento. Esta actividad, en términos de CMI, no se relaciona con el tipo de clon, ST, carbapenemasa, ni con la presencia de genes que codifican bombas de expulsión.(AU)

Cribado e intervención breve en consumo de alcohol / Screening and brief intervention on alcohol consumption

La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.(AU)

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that “moderate” consumption is beneficial to health. The most recent evidence indicates that “moderate” consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.(AU)

Factores de riesgo del suicidio consumado en los jóvenes y los adultos de mediana edad: estudio poblacional forense / Risk factors for completed suicide in young people and middle-aged adults: Population forensic study

Introducción: El suicidio es un problema importante de salud pública. El objetivo del estudio es analizar las características demográficas, clínicas y toxicológicas, y los métodos del suicidio en jóvenes y adultos de mediana edad.MétodoEl estudio fue retrospectivo poblacional del suicidio consumado en sujetos de 14-55 años que fueron objeto de autopsia forense en Bizkaia entre 2016-2018.ResultadosSe registraron 272 suicidios. La incidencia global fue de 7,8/100.000 habitantes/año. Ciento veintisiete tenían entre 14 y 55 años. La tasa fue 3 veces superior en los varones y se incrementó con la edad. En el 72% se recogió algún factor de riesgo clínico, predominando los trastornos mentales (59%): del estado de ánimo (23%), por abuso de sustancias (20,5%) y psicóticos (14%). El 38% de los adictos tenía otro trastorno mental. La enfermedad física (23%) y el intento de suicidio (20,5%) fueron los factores relevantes. El 41% fueron positivos para sustancias de abuso: etanol (22%), cannabis (16%), cocaína (11%) y anfetamina (8%). Este porcentaje fue del 79% en los adictos a sustancias. Los trastornos por abuso de sustancias (25% vs. 6,5%; p = 0,03) y la presencia de alcohol y/o drogas (49% vs. 16%; p = 0,001) fueron más prevalentes en los varones.ConclusionesLa incidencia del suicidio en Bizkaia es más baja que la media europea. El suicidio es un problema complejo asociado a factores demográficos, clínicos (principalmente, trastornos depresivos y abuso de sustancias) y al consumo reciente de alcohol y drogas ilegales. Para identificar los factores de riesgo y orientar las medidas preventivas se requieren investigaciones prospectivas multidisciplinares y multicéntricas. (AU)

Introduction: Suicide is a major public health problem. The objective of this study is to analyze the demographic, clinical and toxicological characteristics and the mechanisms of suicide in young people and middle-aged adults.MethodRetrospective population study of completed suicide in subjects aged 14-55 who were subjected to a forensic autopsy in Bizkaia between 2016-2018.Results272 suicides were recorded. The global incidence was 7.8/100.00 inhabitants/year. 127 were 14-55 years old. The rate was 3 times higher in men and increased with age. In 72%, some clinical risk factor was collected, mainly mental disorders (59%): mood disorders (23%), substance abuse (20.5%) and psychotic disorders (14%). 38% of addicts had another mental disorder. Physical illness (23%) and suicide attempt (20.5%) were also relevant factors. 41% were positive for alcohol and/or illicit drugs: ethanol (22%), cannabis (16%), cocaine (11%) and amphetamine (8%). This percentage was 79% in substance addicts. Substance abuse disorders (25% vs. 6.5%; p = 0.03) and presence of alcohol and/or drugs (49% vs. 16%; p = 0.001) were more prevalent in men. The most commonly used methods were fall from heights (35%) and hanging (31%).ConclusionsThe incidence of suicide in Bizkaia is lower than the European average. Suicide is a complex problem associated with demographic and clinical factors (mainly depressive and substance abuse disorders) and recent use of alcohol and illicit drugs. Prospective multidisciplinary and multicenter researches are required in order to identify risk factors and to guide preventive measures. (AU)

Sumisión química en casos de presuntos delitos contra la libertad sexual 2016-2018, Lima, Perú / Chemical submission in cases of alleged crimes against sexual freedom 2016-2018, Lima, Peru

Introducción: La sumisión química es el uso de sustancias químicas con el fin de manipular la voluntad en las personas produciendo una incapacidad o inconsciencia que facilita la acción criminal, por lo que han tomado un gran protagonismo en los últimos años, debido al uso frecuente en los casos de presuntos delitos contra la libertad sexual.Materiales y métodosSe ha realizado un estudio observacional descriptivo-retrospectivo de casos de presuntos delitos contra la libertad sexual ejercidos mediante sustancias químicas, con el fin de determinar el perfil de las víctimas según las muestras analizadas y las sustancias detectadas en los años 2016, 2017 y 2018, que han sido registrados en la Dirección de Criminalística (DIRCRI) de la Policía Nacional del Perú (PNP).ResultadosDe los 1841 casos de delito contra la libertad sexual, 445 (24,17±2%) cumplieron los criterios de inclusión. El perfil de la víctima es de una mujer limeña joven con una edad media de 22,56±1,14 años. La procedencia de casos fue San Juan de Lurigancho (10,56±2,9%). Las muestras remitidas han sido orina (62,47±4,5%), y en conjunto con el sarro ungueal (37,53±4,5%). El análisis toxicológico de los casos probables han sido sustancias identificadas como psicofármacos (57,53±4,6%, fundamentalmente benzodiacepinas), etanol (26,29±4,1%), y drogas ilícitas (11,24±2,9%, fundamentalmente marihuana y cocaína), solas o en combinación.ConclusionesEl estudio demostró que el 24,17±2% fueron casos probables de mujeres limeñas, agredidas sexualmente bajo efectos de sustancias químicas, predominando el distrito de San Juan de Lurigancho con el 10,56±2,9%, cuya mayoría de muestras analizadas fueron a partir de la orina con el 62,47±4,5%; el grupo de sustancias en el que más prevalencia se obtuvo fueron los psicofármacos con 57,53±4,6%, siendo las benzodiacepinas los únicos subgrupos que fueron registrados. (AU)

Introduction: Chemical submission is the use of chemical substances to manipulate the will of a person, producing incapacity or unconsciousness that facilitates criminal action. It has gained in prominence in recent years, due to its frequent use in cases of alleged crimes against sexual freedom.Materials and methodsAn observational descriptive-retrospective study of cases of alleged crimes against sexual freedom committed using chemical substances was carried out, to determine the profile of the victims according to the samples analysed and the substances detected in 2016, 2017 and 2018,registered with the Criminalistics Directorate (DIRCRI) of the Peruvian National Police (PNP).ResultsOf the 1841 cases of crime against sexual freedom, 445 (24.17%±2%) met the inclusion criteria. The victim's profile is that of a young (Lima) woman (mean age: 22.56±1.14 years). The cases were from San Juan de Lurigancho (10.56%±2.9%). The samples submitted were urine (62.47%±4.5%), and urine and nail plaque (37.53%±4.5%). The toxicological analysis of probable cases showed substances identified as psychotropic drugs (57.53%±4.6%, mainly benzodiazepines), ethanol (26.29%±4.1%), and illicit drugs (11.24%±2.9%, mainly marijuana and cocaine), alone or in combination.ConclusionsThe study showed that 24.17%±2% were probable cases of Lima women who had been sexually assaulted under the influence of chemical substances, predominantly in the district of San Juan de Lurigancho at 10.56%±2.9%, most of the samples analysed were urine with 62.47%±4.5%; the most prevalent group of substances were psychotropic drugs at 57.53%±4.6%, with benzodiazepines being the only subgroups that were recorded. (AU)

Tiapride, una alternativa de tratamiento para el trastorno por el uso de alcohol: a propósito de un caso / Tiapride, an alternative treatment for alcohol use disorder: a case report

Objetivo: Exponer a través de un caso clínico el uso de tiapride para la desintoxicación de alcohol en un paciente con diagnóstico de trastorno por el uso de alcohol.Caso clínicoUna mujer de 50 años, en seguimiento en la Unidad de Conductas Adictivas desde septiembre de 2016 hasta la actualidad, con diagnósticos de trastorno de adaptación con alteración mixta de las emociones, trastorno por consumo de alcohol y descompensación maniforme, ante lo cual se le instaura el tratamiento con tiapride.ResultadosLos estudios consultados demuestran la eficacia y seguridad de tiapride para el síndrome de abstinencia al alcohol, tanto en el ámbito ambulatorio como hospitalario, en monoterapia o en politerapia con benzodiacepinas y/o antiepilépticos, siendo usado también en la agitación y/o sintomatología psicótica.ConclusionesEn el síndrome de abstinencia al alcohol se ha observado que el tiapride es eficaz, pudiendo incluso tenerlo en cuenta como un tratamiento coadyuvante a las benzodiacepinas o los anticonvulsivantes. Con vistas al futuro, se deberían tener en cuenta la farmacogenética que afecta al trastorno por consumo de alcohol, con lo que se podría beneficiar, con menores efectos adversos, a una terapia personalizada individualizada. (AU)

Objective: To present a case report on the use of tiapride for alcohol detoxification in a patient diagnosed with alcohol use disorder.Clinical caseA 50-year-old woman, under follow-up in the Addictive Behaviour Unit from September 2016 to date, with a diagnosis of adjustment disorder with mixed emotional disturbance, alcohol use disorder and mood decompensation, for which treatment with tiapride was initiated.ResultsThe studies consulted demonstrate the efficacy and safety of tiapride for alcohol withdrawal syndrome, in both outpatient and inpatient settings, in monotherapy or in polytherapy with benzodiazepines and/or antiepileptics, and used for agitation and/or psychotic symptoms.ConclusionsTiapride has been found to be effective in alcohol withdrawal syndrome and could even be considered adjunctive treatment to benzodiazepines or anticonvulsants. Looking to the future, pharmacogenetics affecting alcohol use disorder should be considered, and this could result in tailored, personalised therapy, with fewer adverse effects. (AU)

¿Sabemos lo que es un consumo moderado de alcohol? El caso particular de la cerveza / Do we know what moderate alcohol consumption is? The particular case of beer

Actualmente existe una gran controversia relativa a la falta de definición respecto a lo que se considera un consumo moderado de bebidas alcohólicas desde el punto de vista de la salud, ya que, a su vez, debería ser un consumo socialmente aceptado. Aunque no existe una definición universalmente consensuada de consumo moderado, se considera como tal la cantidad por debajo de 10-12 g de alcohol al día para mujeres y de no más de 20-24 g alcohol al día para hombres.Estas diferencias se deben a la menor capacidad de las mujeres para metabolizar el alcohol. De acuerdo con la evidencia científica, parece aceptarse que el consumo moderado de cerveza puede colaborar en mantener una adecuada calidad de la dieta, ya que aporta vitaminas del complejo B (vitamina B6, B12 y folatos) y minerales (magnesio), entre otros nutrientes, así como polifenoles y carbohidratos complejos. En referencia a la salud, se ha atribuido a la cerveza un papel protector a nivel cardiovascular, asociado a un mejor perfil lipídico. Todo ello podría indicar un papel protector a nivel cardiovascular. También es importante señalar que el posible efecto beneficioso de un consumo moderado de bebidas fermentadas (como la cerveza) está asociado a otros factores como el sexo, la edad y el patrón de consumo a lo largo de la vida. (AU)

There is currently a great controversy about the lack of definition regarding the concept of moderate consumption of alcoholic beverages from the point of view of health, since, in turn, it should be a socially accepted consumption. Although still there is not a global agreement about the definition of “moderate consumption”, it is considered as such the amount below 10-12 g alcohol/day for women and no more than 20-24g alcohol/day for men.These differences are because that women are not capable as men to metabolise alcohol. According to the scientific evidence, moderate consumption of beer seems to be accepted to maintain an adequate quality of the diet, as it provides vitamins B (vitamin B6, B12 and folates) and minerals (magnesium) among other nutrients, as well as poliphenols and complex carbohydrates. In terms of health, a moderate beer consumption may play a protective role at cardiovascular levels, associated with an enhanced lipid profile. It should be highlighted the possible beneficial effects of a moderate consumption of fermented beverages (such as beer) is associated with other factors, such as gender, age, as well as the pattern of consumption throughout life. (AU)

Alcohol Protective Behavioral Strategies in Young Spanish Adults in the Community: A Prospective Study of Perceived Efficacy and Social Norms / Uso de Estrategias Conductuales de Protección Entre Jóvenes-Adultos Españoles: un estudio Prospectivo de la Eficacia Percibida y las Normas Sociales

Background: Protective behavioral strategies (PBS) have been shown tobe useful for reducing excessive alcohol use and alcohol-related problems. However, research on the explanatory factors of PBS is limited. This paperprospectively examines the contribution of perceived efficacy of PBS inreducing alcohol-related consequences and perceived descriptive normsof close peers ́ PBS use in young adults. The mediating role of perceivedefficacy of PBS between descriptive norms of PBS use and personal PBS use is also examined. Method: Targeted sampling was used to recruit acommunity-based sample of 339 young Spanish adults aged 18-25 years,who completed baseline and two-month follow-up questionnaires. Threetypes of PBS (serious harm reduction-SHR, manner of drinking-MOD, andstopping/limiting drinking-SLD) were measured. Results: Both perceivedefficacy and descriptive norms at baseline were positively associated withpersonal PBS use (SHR, MOD and SLD) at follow-up. A partial mediationeffect of perceived efficacy between descriptive norms and personal PBS use was found for the three PBS subscales.Conclusions: Our findingssupport the usefulness of correcting misperceptions of PBS use by peersin interventions aimed at reducing excessive drinking and alcohol-relatedconsequences in young adults in the community. Moreover, PBS perceivedefficacy should be included as a component of these interventions.

Antecedentes: las estrategias conductuales de protección (ECP)han mostrado utilidad para reducir el consumo excesivo de alcohol y sus problemas asociados, aunque la investigación sobre sus factores explicativos es escasa. Este trabajo examina la contribución de la eficacia percibida delas ECP para reducir las consecuencias negativas del alcohol, y la norma descriptiva percibida del uso de PBS de los iguales, en adultos jóvenes. Además, analiza el papel mediador de la eficacia percibida entre norma descriptiva y ECP. Método: mediante muestreo dirigido a poblacionesdiana, 339 jóvenes españoles (18-25 años) comunitarios cumplimentaron cuestionarios basal y de seguimiento (dos meses), midiéndose tres tipos deECP (reducción de daños-RR, forma de beber-FB, parar/limitar el consumo-PLC). Resultados: eficacia y norma se asociaron positivamente con el uso deECP (RR/FB/PLC) en el seguimiento. Para los tres tipos de ECP se detectóun efecto de mediación parcial de la eficacia percibida entre la norma y el usode ECP. Conclusiones: corregir percepciones erróneas del uso de ECP de losiguales puede ser útil en las intervenciones dirigidas a reducir el uso excesivode alcohol y sus consecuencias en adultos jóvenes comunitarios, al igual quela inclusión de la eficacia percibida como uno de sus componentes.

Modelo de sistemas del consumo excesivo de alcohol en estudiantes universitarios / Systems model of binge drinking in college students

El consumo excesivo de alcohol en estudiantes universitarios entre 18 y 25 años produce muertes involuntarias en accidentes automovilísticos, agresiones sexuales y problemas académicos como pérdida de clases, retardos en clase, desempeño deficiente en exámenes o trabajos y calificaciones bajas. Desarrollar modelos de enfermería para explicar esta conducta aumenta el campo de conocimiento de la disciplina. El objetivo es describir la construcción de la teoría de rango medio Modelo de Sistemas del Consumo Excesivo de Alcohol en Universitarios. Este proceso se llevó a cabo la subestructuración de algunos conceptos del Modelo de Sistemas de Neuman. Este modelo es de gran utilidad para tener un acercamiento con la población de jóvenes universitarios y se puede emplear para guiar acciones de prevención del consumo excesivo de alcohol. (AU)

Binge drinking in college students between the ages of 18 and 25 results in unintentional deaths in car accidents, sexual assaults, and academic problems such as missed classes, tardiest in class, poor performance on tests or assignments, and low grades. Developing nursing models to explain this behaviour increases the field of knowledge of the discipline. The objective is to describe the construction of the middle range theory Systems Model of Binge Drinking in College Students, this process was carried out by the theoretical substruction of some concepts of the Neuman Systems Model. This model is very useful to have an approach with the population of young university students and can be used to guide actions to prevent excessive alcohol consumption (AU)