Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study.

AIM: To determine the detection rates, clinical features, and risk factors for lack of registration of alcohol use in medical patients admitted in European hospitals. METHODS: A point-prevalence, cross-sectional, multicenter survey involving 2100 medical inpatients from 43 hospitals from 8 European countries. Patients were screened for current alcohol use, using standardized questionnaires. Alcohol use recording in medical records was assessed. RESULTS: Of the 2100, more than a half reported alcohol use. Significant differences were shown in the prevalence of drinking and the recording rates of alcohol use among the hospitals and countries involved. Overall, 346 patients (16%) fulfilled criteria for alcohol use disorder. Alcohol use was registered in 909 (43%) of medical records, with quantification in 143 (7%). Multivariate analysis showed that women (OR 1.49), older age patients (OR 1.23), patients from the Northern European countries (OR 4.79) and from hospitals with high local alcohol prevalence (OR 1.59) were more likely to have lack of alcohol use registration in their medical files. CONCLUSIONS: A considerable proportion of medical patients admitted in European hospitals fulfill criteria for alcohol use disorders. These patients are frequently overlooked during hospitalization and not appropriately registered in medical records. Women, older patients, and inpatients from European areas with high local alcohol use prevalence are at higher risk associated with a non-recording of alcohol use.

Temporal and spatial patterns in the rate of alcohol withdrawal syndrome in a defined community.

There is a paucity of data about the epidemiology of alcohol withdrawal syndrome (AWS) and, particularly, with regard to temporal trends and sociodemographic factors. This study included 7,195 episodes of AWS in a defined community (Galicia, Spain) over a 11-year period. We looked for geographical correlations between AWS rate and sociodemographic factors (education and socioeconomic levels and rates of occupational activity and unemployment) within respective districts. We also investigated the inter- and intra-annual time trends for AWS. The median age of the participants was 49 years (interquartile range, 41-60 years), and 85% were men. The annual frequency of AWS episodes remained stable during the study period, with a consistent peak in episodes during the summer months and lowest frequency of episodes in winter months (P<.001). The age- and sex-adjusted geographical distribution of the AWS rate was uneven; districts with high rate tended to cluster. The mean education level was negatively correlated with AWS rate within a given district after adjusting for socioeconomic level, occupational activity rate, and unemployment rate (P<.001). In conclusion, we identified characteristic temporospatial patterns of AWS rate in this defined community. The rate of AWS tended to be higher in the summer months and lower in the winter months. The rate of AWS was higher in districts with low education levels.

Prevalence and routine assessment of unhealthy alcohol use in hospitalized patients.

OBJECTIVES: To determine the prevalence of alcohol misuse among medical inpatients and the methods used by medical staff to evaluate alcohol consumption. METHODS: Multicenter, prospective, observational, cross-sectional study performed at 21 hospitals in Spain. All adult patients hospitalized in internal medicine wards on 12 March 2008 were eligible for study. Alcohol consumption was evaluated with the Alcohol Use Disorders Identification Test (AUDIT-C and AUDIT) and the Systematic Inventory of Alcohol Consumption questionnaire. Drinking patterns were determined according to clinical evaluation using ICD-10 criteria. Medical records were reviewed to gather information on the recording of alcohol use. RESULTS: We assessed 1039 inpatients, of whom 123 (12%) had unhealthy alcohol drinking patterns. Alcohol misuse was more frequent among males (odds ratio 5.20), younger patients (odds ratio, 14.17), median age patients (odds ratio, 2.99), and South Region (odds ratio, 1.77). Alcohol use during hospitalization was recorded in 603 inpatients (59%); quantitative records were performed in 28% of hazardous and harmful drinkers and in 41% of dependent patients. Lack of alcohol use recording was more frequent among females (odds ratio 1.73), median and older age groups (odds ratios 1.44 and 1.73, respectively), Northwest Regions (odds ratios 3.46). Patients from the East Region (odds ratio 0.47) had more frequently assessed the question in their medical records. CONCLUSIONS: Prevalence of alcohol misuse was higher in hospitalized patients than in the general population. Adequate quantitative recording was infrequent. We stress the need to implement measures to increase and improve the detection and recording of alcohol use.

Nefritis membranosa lúpica: a propósito de un caso / Lupic membranous nephritis: case report

La nefritis lúpica ha sido considerada desde hace tiempo, como el elemento individual más representativo para establecer un pronóstico global de la enfermedad, por lo que es un buen indicador de la gravedad de la enfermedad sistémica. Hasta hace unos años el 40 por ciento de los pacientes con formas graves de nefritis lúpica evolucionaban hacia la muerte o la insuficiencia renal crónica a los cinco años de evolución. Hoy día, este pronóstico tan pesimista ha mejorado notablemente gracias a los enfiques anatomoclínicos y terapéuticos.

Efecto de la dopamina inhalada en la presión arterial de pacientes con insuficencia renal: cronica en hemodiálisis / Effect of the dopamine inhaled in the presion arterial of patients with insuficience renal: chronic in hemodialisis

La vía común de administración de la Dopamina es la intravenosa a infusión continua con efectos sistémicos que requieren de monitorización cardiovascular. En trabajos anteriores hemos utilizado la dopamina inhalada en pacientes con crisis de asma bronquial y hemos demostrado un efecto broncodilatador. En este estudio prospectivo, evaluamos los efectos de Dopamina inhalada a dosis de 3 µg/kg/min en 21 pacientes con insuficiencia renal crónica en hemodiálisis de los cuales 16 eran hipertensos, 5 normotensos y 11 pacientes normotensos sanos como control. Los resultados nos permiten concluir: 1. La Dopamina inhalada redujo significativamente la presión arterial del grupo control con una presión sistólica de 1162 ± 3,22 mmHg a 100 ± 3,22 mmHg (p<0,002) y el valor de presión diastólica de 72 ± 2,38 mmHg a 65 ± 2,36 mmHg (p<0,05), pero no redujo la presión arterial de los pacientes con Insuficiencia Renal Crónica. 2. Los mecanismos de control de presión arterial en ambos grupos son diferentes, esto condiciona una respuesta cardiovascular distinta a la Dopamina.

Efectos cardiovasculares de la dopamina inhalada en sujetos normotensos con insuficiencia renal crónica en hemodiálisis / Effects cardiovasculary of the dopamiane inhaled in subjects normotensos with insufficiency renal chronic in hemodialysis

Los efectos sistemáticos de la dopamina reportados en la literatura mundial son principalmente por vía intravenosa y dependen de la dosis utilizada. En pacientes con insuficiencia renal crónica se utiliza dopamina con el propósito de mantener la presión arterial durante las lesiones de hemodiálisis. En este estudio prospectivo, evaluamos los efectos cardiovasculares de la dopamina inhalada a dosis de 3 µgr/kg/min en 11 sujetos normotensos sanos y 5 sujetos normotensos con insuficiencia renal crónica en hemodiálisisy los resultados obtenidos nos permiten sugerir, quelos mecanismos de control de la presión arterial en ambos grupos son diferentes y que la dopamina inhalada es una vía alterna de administración con efectos colaterales mínimos: irritación faríngea y sabor amargo