[Effects of including mutual aid groups in the adherence of a continuing care programme of alcohol dependent patients carried out in a Primary Care setting]. / Efectos de la integración de grupos de ayuda mutua sobre la adherencia al programa de continuidad en el cuidado a pacientes con dependencia del alcohol realizado en Atención Primaria.

OBJECTIVES: To demonstrate the effects of including mutual aid associations into a continuing care programme for patients with alcohol dependence carried out by Primary Care teams. SITE: Primary Care Teams belonging to the attendance area of the University Hospital 12 de Octubre at Madrid. PARTICIPANTS: 207 participants with alcohol dependence treated in an intensive hospital outpatient-setting programme were included in a continuing care programme carried out by a Primary Care team for a four-year period. INTERVENTIONS: Patients were randomised into two intervention modalities. The first group was followed up while receiving a treatment modality known as «monitoring recovery¼ (Group A, n = 97). The other group, in addition to the above-mentioned intervention, attended to a mutual aid association included in the Federation of Alcoholics of the Community of Madrid (FACOMA) in which the programme «Help Yourself-Help Us¼ was carried out (Group B, n = 112). MAIN OUTCOMES: Dropout rates on the sessions designed to monitor their recovery from their alcohol dependence and other comorbid medical conditions. RESULTS: Patients in Group B reached higher rates of therapeutic adherence to the programme (47.9% vs. 14.7%, p < 0.01), as well as for the comorbid medical issues when compared to Group A. CONCLUSIONS: Including mutual aid associations that carried out the «Help yourself-Help Us¼ programme for a four-year period improves outcomes related to therapeutic adherence in patients with alcohol dependence attending Primary Care teams.

Neurological manifestations of excessive alcohol consumption. / Manifestaciones neurológicas del alcoholismo.

This article reviews the different acute and chronic neurological manifestations of excessive alcohol consumption that affect the central or peripheral nervous system. Several mechanisms can be implicated depending on the disorder, ranging from nutritional factors, alcohol-related toxicity, metabolic changes and immune-mediated mechanisms. Recognition and early treatment of these manifestations is essential given their association with high morbidity and significantly increased mortality.

Association between hepatitis B co-infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia.

OBJECTIVE: To describe liver disease epidemiology among HIV-infected individuals in Zambia. METHODS: We recruited HIV-infected adults (≥18 years) at antiretroviral therapy initiation at two facilities in Lusaka. Using vibration controlled transient elastography, we assessed liver stiffness, a surrogate for fibrosis/cirrhosis, and analysed liver stiffness measurements (LSM) according to established thresholds (>7.0 kPa for significant fibrosis and >11.0 kPa for cirrhosis). All participants underwent standardised screening for potential causes of liver disease including chronic hepatitis B (HBV) and C virus co-infection, herbal medicine, and alcohol use. We used multivariable logistic regression to identify factors associated with elevated liver stiffness. RESULTS: Among 798 HIV-infected patients, 651 had a valid LSM (median age, 34 years; 53% female). HBV co-infection (12%) and alcohol use disorders (41%) were common and hepatitis C virus co-infection (<1%) was rare. According to LSM, 75 (12%) had significant fibrosis and 13 (2%) had cirrhosis. In multivariable analysis, HBV co-infection as well as male sex, increased age and WHO clinical stage 3 or 4 were independently associated with LSM >7.0 kPa (all P < 0.05). HBV co-infection was the only independent risk factor for LSM >11.0 kPa. Among HIV-HBV patients, those with elevated ALT and HBV viral load were more likely to have significant liver fibrosis than patients with normal markers of HBV activity. CONCLUSIONS: HBV co-infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimise treatment outcomes.

[Alcohol's impact on children and families. A population survey]. / Daño a niños y sus familias por el consumo de alcohol: resultados de una encuesta poblacional.

INTRODUCTION: Alcohol is widely used among young families, and leisure time is frequently family time. Heavy alcohol consumption can adversely affect children. The objective of this work is to measure the harm to others in Chile. SUBJECTS AND METHOD: This descriptive and probabilistic study forms part of a collaborative research funded by Thai Health and WHO. The survey was adapted by co-researchers and applied to a nationally representative sample of 1500 Chileans over 18years of age. RESULTS: A total of 408 respondents (27.2%) lived with children at home. Of this total, 10.5% felt that the use of alcohol by any member of the family had adversely affected a child. The most common adverse effects were verbal violence (29.7%), domestic violence (23.1%), unsupervised homes (18.7%), lack of money to provide basic needs of the child (14.3%), and physical violence (7.7%). Furthermore, in 6.6% of the cases child or family services agencies became involved. In almost half of the cases (46.3%), the drinker was the father, mother or step-parents. This was followed by other relatives (24.4%) and brothers (4.9%), or guardian of the child (2.4%). CONCLUSION: These data support the clinical observation that alcohol is common in Chilean homes. Its consumption not only damages the physical and mental health of the drinker but also those around him. Verbal violence and witnessing serious physical violence are frequent issues, as well as economic problems that end up with the inability to provide the child with its basic needs.

The role of oxidative stress in the development of alcoholic liver disease.

BACKGROUND: Alcohol is the most accepted addictive substance worldwide and its consumption is related to multiple health, economic, and social problems. The liver is the organ in charge of ethanol metabolism and it is susceptible to alcohol's toxic effects. OBJETIVOS: To provide a detailed review of the role of oxidative stress in alcoholic liver disease and the mechanisms of damage involved, along with current information on the hepatoprotective effectiveness of the molecules that have been studied. MATERIALS AND METHODS: A search of the PubMed database was conducted using the following keywords oxidative stress, alcoholic liver damage, alcoholic cirrhosis, and antioxidants. There was no time limit for gathering all available information on the subject at hand. RESULTS: According to the literature reviewed, oxidative stress plays an important role in the pathogenesis of alcoholic liver damage. Molecules such as reactive oxygen species (ROS) and reactive nitrogen species (RNS), formed during ethanol metabolism, structurally and functionally modify organic molecules. Consequently, biologic processes are altered and hepatocytes are sensitized to the action of cytokines like tumor necrosis factor-α, as well as to the action of endotoxins, activating signaling pathways such as those controlled by nuclear factor kappa B, extracellular signal regulated kinases, and mitogen activated protein kinase. CONCLUSIONS: Oxidative stress plays an important role in the development of liver damage resulting from alcohol consumption. The molecules that have currently displayed a hepatoprotective effect in preclinical and clinical trials must be studied further so that their effectiveness can be confirmed and they can possibly be used as adjuvant treatments for this disease.

Trend in mortality from mental and behavioral disorders due to alcohol use in Brazil, 2010-2021 / Tendencias de mortalidad por trastornos mentales y comportamentales relacionados con el consumo de alcohol en Brasil: 2010-2021 / Tendência da mortalidade por transtornos mentais e comportamentais devidos ao uso de álcool no Brasil, 2010-2021

Abstract Objective: To analyze the trend in mortality from mental and behavioral disorders due to alcohol use in Brazil, 2010-2021. Methods: This was an time series study using Mortality Information System data. Annual percentage change (APC) and 95% confidence intervals (95% CI) were calculated using Prais-Winsten linear regression. Results: Mortality showed a stationary trend for Brazil as a whole (APC = 0.6; 95%CI -4.2;3.0), a falling trend in individuals aged 20-29 years in the South (APC = -7.4; 95%CI -10.0;-4.3) and Northeast (APC = -3.4; 95%CI -6.4;-0.4) regions, in people aged 30-39 in the Midwest region (APC = -3,8; 95%CI -7.4;-0.1) and 40-49 in the South (APC = -2.1; 95%CI -3.8;-0.4), North (APC = -3.1; 95%CI -5.7;-0.5) and Midwest (APC = -2.9; 95%CI -5.5;-0.3) regions. Conclusion: Mortality from mental and behavioral disorders due to alcohol use showed a stationary trend nationally and a falling trend in some age groups regionally.

Resumen Objetivo: Analizar la tendencia de mortalidad por trastornos mentales y del comportamiento en decorrencia del consumo de alcohol en Brasil en el período 2010-2021. Métodos: Estudio de series de tiempo ecológicas, con datos del Sistema de Información de Mortalidad; el cambio porcentual anual (APV) y los respectivos intervalos de confianza del 95% (IC95%) se calcularon mediante regresión lineal de Prais-Winsten. Resultados: Hubo una tendencia estacionaria en la mortalidad en Brasil en su conjunto (VPA = 0,6; IC95% -4,2;3,0), una tendencia decreciente en individuos de 20 a 29 años en las regiones del Sur (VPA = -7,4; IC95% -10,0;-4,3) y Noreste (VPA = -3,4; IC95% -6,4;-0,4), en personas de 30 a 39 años en el Centro-Oeste (VPA = -3,8; IC95% -7,4;-0,1) y en adultos de 40 a 49 años en el Sur (VPA = -2,1; IC95% -3,8;-0,4), Norte (VPA = -3,1; IC95% -5,7;-0,5) y Centro-Oeste (VPA = - 2,9; IC95% -5,5;-0,3). Conclusión: La mortalidad por trastornos mentales y del comportamiento a causa del consumo de alcohol presentó una tendencia estacionaria en Brasil y una tendencia decreciente en algunos grupos etarios.

Resumo Objetivo: Analisar a tendência da mortalidade por transtornos mentais e comportamentais devidos ao uso de álcool no Brasil em 2010-2021. Métodos: Estudo de séries temporais, com dados do Sistema de Informação sobre Mortalidade. A variação percentual anual (VPA) e respectivos intervalos de confiança de 95% (IC95%) foram calculados por regressão linear de Prais-Winsten. Resultados: Houve tendência estacionária na mortalidade no Brasil como um todo (VPA = 0,6; IC95% -4,2;3,0), tendência decrescente em indivíduos de 20-29 anos nas regiões Sul (VPA = -7,4; IC95% -10,0;-4,3) e Nordeste (VPA = -3,4; IC95% -6,4;-0,4), em pessoas de 30-39 anos no Centro-Oeste (VPA = -3,8; IC95% -7,4;-0,1) e naqueles com 40-49 anos nas regiões Sul (VPA = -2,1; IC95% -3,8;-0,4), Norte (VPA = -3,1; IC95% -5,7;-0,5) e Centro-Oeste (VPA = -2,9; IC95% -5,5;-0,3). Conclusão: A mortalidade por transtornos mentais e comportamentais devidos ao uso de álcool apresentou tendência estacionária no Brasil e decrescente em algumas faixas etárias.

Implementación del proceso de atención de enfermería en paciente con Gangrena de Fournier / Implementation of the nursing care process in patient with Fournier's Gangrene

la gangrena de Fournier es una fascitis necrosante tipo I que afecta a los hombres y mujeres en cualquier edad, se origina por una infección de la región perianal, genital y del tercio inferior del abdomen, es de etiología polimicrobiana y puede ocurrir propagación hasta la clavícula; esta patología, presenta una alta tasa de mortalidad, por lo que requiere tratamiento rápido y agresivo. Objetivo: identificar las necesidades de paciente Gangrena de Fournier, e implementar el proceso de atención de enfermería (PAE), realizando valoración y elaboración de los diagnósticos según la Taxonomía de North American Nursing Diagnosis Association (NANDA). Se presenta caso de paciente masculino de 38 años de edad, el cual presentaba lesión ulcerada de aproximadamente 8 cm de longitud en área perianal, con bordes irregulares, endurecidos, fétido, acompañado de dolor a la palpación, caliente al tacto, presencia de afectación muscular (esfinteranal externo), localizado en región perianal anterior, que se comunica con región contralateral del glúteo derecho, acompañado de cambios inflamatorios, aproximadamente 5cc de secreción purulenta. Paciente fue sometido a desbridamiento y limpieza en región afectada; en el proceso de atención de enfermería (PAE), se realizó valoración y elaboración de los diagnósticos según la Taxonomía NANDA: 1) Dolor agudo 2) Deterioro de la integridad tisular 3) Riesgo de infección 4) inestabilidad emocional. Además, se elaboró el plan de intervención con Nursing Outcomes Classification (NOC) y Nursing Interventions Classification (NIC)...(AU)

Bienestar psicológico y consumo de sustancias psicoactivas en adultos jóvenes del Quindío / Psychological well-being and consumption of psychoactive substances in young adults from Quindío

El consumo de Sustancias Psicoactivas (SPA) es una problemática que por años ha generado afectaciones en los ámbitos individual y colectivo, contribuyendo al aumento en las cifras de problemáticas psicosociales y de salud. El objetivo del estudio fue establecer la relación entre el bienestar psicológico y el consumo de SPA en 97 personas de 18 a 25 años del departamento del Quindío. Para ello, se implementó un diseño transversal con alcance correlacional. Los datos se recolectaron mediante la Prueba de Detección de Consumo de Alcohol, Tabaco y otras Sustancias y la Escala del Bienestar Psicológico de Ryff. Se identificó que la mayoría de los participantes se ubicaron en un nivel alto en la mayoría de las dimensiones de la escala de bienestar. El 91,75% de los participantes consumieron alguna sustancia, a lo largo de su vida. Finalmente, se encontró una relación entre la preocupación por otros por el consumo de tabaco y el bajo nivel de autonomía (-0,3144, p < 0,01), y el intento por dejar el consumo alcohol y bajo nivel del dominio del entorno (-0,3275, p < 0,01).

The consumption of psychoactive substances (PAS) generates affectations in the individual and collective spheres, contributing to the increase in the figures of psychosocial and health problems. The objective of the study was to establish the relationship between the consumption of PAS and psychological well-being in 97 people between 18 and 25 years of age in the department of Quindío. For this, a cross-sectional design with correlational scope was implemented. Data were collected using the Alcohol, Tobacco, and Other Substance Use Screening Test and the Ryff Psychological Well-Being Scale. It was identified that the majority of those evaluated were located at a high level in most of the dimensions of the well-being scale. 91,75% of the participants consumed some substance throughout their lives. Finally, a relationship was found between concern for others about tobacco consumption and low level of autonomy (-0,3144, p < 0.01), and the attempt to quit alcohol consumption and low level of mastery of environment (-0,3275, p < 0.01).

Alcohol, su dependencia y estrategias de afrontamiento según la Terapia Cognitiva / Álcool, sua dependência e enfrentamento do estresse segundo a Terapia Cognitiva / Alcohol, its dependence and coping streies according to Cognitive Therapy

El uso de sustancias psicoactivas contribuye a la aparición de diferentes trastornos cuando se asocia con variaciones sociales y la fisiopatología del individuo, como aspectos genéticos, ambientales y neurológicos. Así, surge la necesidad de producir métodos de revisión de la literatura, entre los cuales destacamos la revisión integradora. Las palabras clave "alcohol" Y "estrategias de afrontamiento" Y "terapia cognitiva" fueron cruzadas en las bases de la Biblioteca Virtual en Salud (BVS) y SciELO, resultando en 200 artículos publicados en portugués, inglés y español, de 2018 a 2022. La inclusión los criterios fueron: ser un artículo de investigación completo; publicado en portugués, inglés y español; estar disponible electrónicamente y abordar el tema en estudio. Los resultados indicaron avances en prácticas que involucran la práctica de la TC y que, asociadas a otras técnicas de intervención, modifican el perfil tradicional de atención al paciente. Así, la literatura apunta para una mayor demanda de rehabilitación en la que se inserta la Terapia Cognitivista AU

O uso de substâncias psicoativas contribuem para o aparecimento de diferentes transtornos quando associadas a variações sociais e à fisiopatologia do indivíduo, como aspectos genéticos, ambientais e neurológicos. Desta forma, há necessidade de produção demétodos de revisão de literatura, dentre estes, destacamos a revisão integrativa. Foram cruzados os unitermos "álcool" AND "estratégias de enfrentamento" AND "terapia cognitiva" nas bases da Biblioteca Virtual em Saúde (BVS) e SciELO, resultando em 200 artigos publicados em português, inglês e espanhol, no período de 2018 a 2022. Os critérios de inclusão foram: ser artigo de pesquisa completo; publicado nos idiomas português, inglês e espanhol; estar disponível eletronicamente e abordar o tema em estudo. Os resultados indicaram avanços nas práticas que envolvem a prática da TC e que associadas a outras técnicas de intervenção, modificam o perfil tradicional de atenção aos pacientes. Assim a literatura aponta uma maior demanda de reabilitação na qual a Terapia Cognitivista está inserida AU

The use of psychoactive substances contributes to the appearance of different disorders when associated with social variations and the pathophysiology of the individual, such as genetic, environmental and neurological aspects. Thus, there is a need to produce literature review methods, among which we highlight the integrative review. The keywords "alcohol" AND "coping strategies" AND "cognitive therapy" were crossed in the bases of the Virtual Health Library (VHL) and SciELO, resulting in 200 articles published in Portuguese, English and Spanish, from 2018 to 2022. The inclusion criteria were: being a complete research article; published in Portuguese, English and Spanish; be electronically available and address the topic under study. The results indicated advances in practices that involve the practice of CT and that, associated with other intervention techniques, modify the traditional profile of patient care. Thus, the literature points to a greater demand for rehabilitation in which Cognitivist Therapy is inserted AU

Intervención educativa sobre el alcoholismo y sus consecuencias para la salud en adolescentes de preuniversitario

Introducción: El alcoholismo es una enfermedad crónica incurable y la toxicomanía de mayor relevancia mundial. El consumo de alcohol se ha incrementado en la adolescencia, lo que confiere relevancia a la prevención y connota la importancia de exponer el nivel de conocimientos acerca del alcoholismo y sus consecuencias perjudiciales para la salud en adolescentes. Método: intervención educativa en adolescentes del municipio Camagüey, de diciembre de 2021 a mayo de 2022. El universo estuvo conformado por los adolescentes de onceno grado del Instituto preuniversitario Enrique José Varona, Reparto Julio Antonio Mella, perteneciente al área de salud del mismo nombre en el municipio Camagüey. La muestra seleccionada de forma intencional quedó integrada por 22 estudiantes. Se utilizaron métodos teóricos y de los empíricos el APGAR familiar, el cuestionario AUDIT y un cuestionario sobre conocimientos de alcoholismo, aplicado antes y después de la intervención. Resultados: cerca de la mitad de la muestra (45,56 %) percibió algún grado de disfunción familiar y el 90,90 % de los adolescentes había ingerido bebidas alcohólicas antes, aunque se constató bajo riesgo al consumo de alcohol en el 95,45 % de la muestra. Antes de la intervención el 72,73 % de los estudiantes tenía bajo nivel de conocimientos y después de la misma todos se ubicaron en niveles entre alto (68,18 %) y medio (31,82 %). Discusión: las intervenciones educativas grupales de tres sesiones o más, son eficaces en la prevención del consumo de alcohol en adolescentes, con independencia de su contenido; lo que explica que la presente investigación corrobore sus potencialidades en pos de una mejoría importante en el nivel de conocimientos de los adolescentes de preuniversitario acerca del alcoholismo y sus consecuencias perjudiciales para la salud.

Introduction: Alcoholism is an incurable chronic disease and the world-wide drug addiction. Alcohol consumption has been increased in adolescence, which confers relevance to the prevention and connotes the importance of exposing the level of knowledge about alcoholism and its harmful consequences for adolescent health. Method: an educational intervention in adolescents from the Camagüey municipality, from December 2021 to May 2022. The universe was made up of eleventh-grade teenagers from the Enrique José Varona Pre-University Institute, Julio Antonio Mella neighborhood, belonging to the health area of the same name in the Camagüey municipality. The intentionally selected sample was integrated by 22 students. Theoretical methods were used and of the empirical ones, the family APGAR, the AUDIT questionnaire and a questionnaire on knowledge of alcoholism, applied before and after the intervention. Results: about half of the sample (45.56%) perceived some degree of family dysfunction and the 90.90% of adolescents had ingested alcoholic beverages before, although low risk of alcohol consumption was found in 95.45% of the sample. Before the intervention, 72.73% of the students had a low level of knowledge and after it everyone located at levels between high (68.18%) and medium (31.82%). Discussion: group educational interventions of three sessions or more are effective in the prevention of alcohol consumption in adolescents, with independence of its content; which explains that the present research corroborates its potential in pursuit of an important improvement in the level of knowledge of college adolescents about alcoholism and its harmful consequences to health.

Analysis of the relationship between interleukin polymorphisms within miRNA-binding regions and alcoholic liver disease. / Análisis de la relación entre polimorfismos en regiones diana de micro-ARN y la enfermedad hepática alcohólica.

INTRODUCTION: Alcohol consumption promotes inflammation through the Toll-like receptor 4 (TLR4)/nuclear factor (NF)-?B pathway, leading to organic damage. Some micro-RNA (miRNA) molecules modulate this inflammatory response by downregulating TLR4/NF-?B pathway mediators, like interleukins (ILs). Thus, polymorphisms within IL genes located near miRNA binding sites could modify the risk of ethanol-induced damage. The present study analyzed potential relationships between alcoholism or alcoholic liver disease (ALD) and IL12B 2124 G>T (rs1368439), IL16 5000 C>T (rs1131445), IL1R1 3114 C>T (rs3917328), and NFKB1 3400 A>G (rs4648143) polymorphisms. PATIENTS AND METHODS: The study included 301 male alcoholic patients and 156 male healthy volunteers. Polymorphisms were genotyped using TaqMan® PCR assays for allelic discrimination. Allele and genotype frequencies were compared between groups. Logistic regression analysis was performed to analyze the inheritance model. RESULTS: Analysis of the IL1R1 (rs3917328) polymorphism showed that the proportion of alleleT carriers (CT and TT genotypes) was higher in healthy controls (9.7%) than in alcoholic patients (6.5%; P=.042). However, multivariable logistic regression analyses did not yield a significant result. No differences between groups were found for other analyzed polymorphisms. CONCLUSIONS: Our study describes, for the first time, the expected frequencies of certain polymorphisms within miRNA-binding sites in alcoholic patients with and without ALD. Further studies should be developed to clarify the potential relevance of these polymorphisms in alcoholism and ALD development.

Factores predisponentes a enfermedades no transmisibles en un área de salud del municipio de Santiago de Cuba / Predisposing factors to non-communicable diseases in a health area from Santiago de Cuba municipality i: en

Introducción: Hoy en día las enfermedades no transmisibles constituyen un grave problema que afecta el estado de salud de la población, con una tendencia ascendente preocupante. Objetivo: Identificar los factores predisponentes a las enfermedades no transmisibles en pacientes de un área de salud. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 286 individuos, escogidos a través de un muestreo aleatorio bietápico en el área de salud Josué País García del municipio de Santiago de Cuba, durante el 2021. Las variables analizadas fueron antecedentes patológicos personales, consumo de productos del tabaco y alcohol, hábitos dietéticos y evaluación nutricional. Se utilizaron como medidas de resumen las frecuencias absolutas, el porcentaje y la tasa de prevalencia para variables cualitativas; la media aritmética y el mínimo e intervalo de confianza para variables cuantitativas. Resultados: El mayor riesgo de presentar hipertensión arterial figuró en las féminas (35,6 %) y existió alta prevalencia de fumadores en hombres (30,5 %) y mujeres (27,7 %). Asimismo, predominaron la exposición al humo de tabaco (fumadores pasivos) y el consumo de alcohol en edades tempranas (25-34 años). De los encuestados, 33,3 % resultó estar sobrepeso u obeso. Conclusiones: Los factores predisponentes a las enfermedades no transmisibles pudieran estar asociados con estilos de vida no saludables como el consumo de productos del tabaco y el alcohol, los hábitos dietéticos inadecuados y el sobrepeso.

Introduction: Nowadays non-communicable diseases are a serious problem that affects the health of the population, with a worrying upward tendency. Objective: To identify the predisposing factors to non-communicable diseases in patients from a health area. Methods: An observational, descriptive and cross-sectional study of 286 individuals, chosen by a two-stage random sampling in Josué País García health area from Santiago de Cuba municipality, was carried out during 2021. The analyzed variables were personal pathological history, consumption of tobacco and alcohol products, dietary habits and nutritional evaluation. The absolute frequencies, percentage and prevalence rate were used as summary measures for qualitative variables; the arithmetic mean and the minimum and interval of confidence were used for quantitative variables. Results: The highest risk of presenting hypertension was in females (35.6%) and there was a high prevalence of smokers in men (30.5%) and women (27.7%). Also, the exposure to tobacco smoke (passive smokers) and alcohol consumption at an early age (25-34 years) prevailed. Of those interviewed, 33.3% was overweight and obese. Conclusions: The predisposing factors to non-communicable diseases could be associated with the non healthy lifestyle as the consumption of tobacco and alcohol products, inadequate dietary habits and overweight.

Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso / Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

Aspectos clínico-epidemiológicos de pacientes con tuberculosis, Guantánamo 2013-2018

Introducción: A pesar de los esfuerzos de la ciencia para la eliminación de la tuberculosis, esta es considerada actualmente una enfermedad reemergente. En provincia Guantánamo no se encontraron investigaciones referida a este tema. Objetivo: Describir los aspectos clínico-epidemiológicos de pacientes con tuberculosis en el periodo comprendido de 2013-2018 en la provincia de Guantánamo. Método: Se realizó un estudio descriptivo, transversal retrospectivo de pacientes con tuberculosis. El universo de estudio quedó constituido por 103 pacientes (N꓿103) constatados en la base de datos del programa Centro Provincial de Higiene, Epidemiología y Microbiología Guantánamo. Las variables estudiadas fueron: edad, sexo, grupo de riesgo, municipio al que pertenece y formas clínicas. Se utilizó como medida de resumen la frecuencia absoluta y relativa. Resultados: El mayor número de pacientes con tuberculosis se encontró en el grupo de 40-49 años (28,16 %), se destacó el grupo de 50-59 del sexo masculino con un 15,53 %. El municipio que más casos aportó fue el de Guantánamo con 67 (65,04 %), seguido de Jamaica con 10 casos (9,70 %). De los pacientes diagnosticados: 43 fueron fumadores (50,0 %), 19 alcohólicos (22,10 %) y 11 desnutridos (12,79 %). Se obtuvo como resultado que 72 pacientes (69,90 %) presentaron la forma pulmonar y 31 (30,10 %) presentaron la forma extrapulmonar. Conclusiones: A pesar de una adecuada red de diagnóstico, tratamiento y seguimiento de la tuberculosis en la provincia de Guantánamo, existen condiciones que determinan la ocurrencia de esta: factores socioeconómicos, sanitarios e individuales inadecuados, hacinamiento, desnutrición, alcoholismo, predisponen a la enfermedad.

Introduction: Despite the scientific efforts to eliminate tuberculosis, it is currently considered as a reemerging disease. In Guantánamo province, no research closely related to the subject was found. Objective: To describe the clinical-epidemiologic aspects of patients with tuberculosis in Guantánamo province, period 2013-2018. Method: A descriptive, retrospective cross-sectional study of patients with tuberculosis was carried out. The study involved a total of 103 patients (N꓿103) recorded in a database manages at the Centro Provincial de Higiene, Epidemiología y Microbiología of Guantánamo. The variables studied were as follow: age, sex, risk group, municipality to which patients belong and, clinical forms. The absolute and relative frequencies were used as summary statistics method. Results: The highest number of patients with tuberculosis was found in 40 to 49 years age group (28.16%), and the male sex stood out in the group of age 50 to 59 (15.53%). The municipality with the highest number of cases was Guantánamo with 67 patients (65.04%), followed by Jamaica municipality with 10 patients (9.70%). Forty three of all the patients diagnosed with tuberculosis (50,0%) were addicted to smoking, 19 (22,10%) addicted to alcohol, and 11 (12,79%) in malnutrition state. As a result in the study, it was found in 72 patients (69.90%) presence of pulmonary tuberculosis and extrapulmonary tuberculosis in 31 active patients (30.10%). Conclusions: Despite of an adequate network of diagnosis, treatment and tuberculosis follow-up in the province of Guantánamo, there are several factors that determine the presence of the disease: for instance, the inadequate use of socioeconomic, sanitary and individual factors, including also aspects like overcrowding, malnutrition, and alcoholism.

Introdução: Apesar dos esforços da ciência para eliminar a tuberculose, atualmente é considerada uma doença reemergente. Na província de Guantánamo, não foram encontradas investigações relacionadas a este tema. Objetivo: Descrever os aspectos clínico-epidemiológicos de pacientes com tuberculose no período de 2013-2018 na província de Guantánamo. Método: Estudo descritivo, retrospectivo e transversal de pacientes com tuberculose. O universo do estudo foi composto por 103 pacientes (nº 103) encontrados no banco de dados do programa Centro Provincial de Higiene, Epidemiologia e Microbiologia de Guantánamo. As variáveis estudadas foram: idade, sexo, grupo de risco, município a que pertence e formas clínicas. Frequência absoluta e relativa foram usadas como medida sumária. Resultados: O maior número de doentes com tuberculose foi encontrado na faixa etária de 40 a 49 anos (28,16%), destacando-se a faixa de 50 a 59 anos do sexo masculino com 15,53%. O município que mais contribuiu com casos foi Guantánamo com 67 (65,04%), seguido de Jamaica com 10 casos (9,70%). Dos pacientes diagnosticados: 43 eram tabagistas (50,0%), 19 etilistas (22,10%) e 11 desnutridos (12,79%). Obteve-se como resultado que 72 pacientes (69,90%) apresentavam a forma pulmonar e 31 (30,10%) apresentavam a forma extrapulmonar. Conclusões: Apesar de uma rede adequada para o diagnóstico, tratamento e monitoramento da tuberculose na província de Guantánamo, existem condições que determinam sua ocorrência: fatores socioeconômicos, de saúde e individuais inadequados, superlotação, desnutrição, alcoolismo, predispõem à doença.

Internações por transtornos mentais e comportamentais devidos ao uso de álcool no Brasil e regiões: análise de tendência temporal, 2010-2020 / Hospitalizaciones por trastornos mentales y de conducta por consumo de alcohol en Brasil y regiones: análisis de tendencia temporal, 2010-2020 / Hospitalizations for mental and behavioral disorders due to alcohol use in Brazil and regions: a temporal trend analysis, 2010-2020

Objective: to analyze the trend in hospitalization rates for mental and behavioral disorders due to alcohol use (ICD-10: F10.0), Brazil and its five regions, 2010-2020. Methods: this was an ecological time-series study using data from the Hospital Information System of the Brazilian National Health System; to calculate the trend in hospitalizations, we used the Prais-Winsten generalized linear regression model and the Stata Statistical Software 14.0; a decreasing trend was considered when p-value < 0.05, and the regression coefficient was negative. Results: in the period analyzed, there were 423,290 hospitalizations for mental and behavioral disorders due to alcohol use in the country; the data analyzed showed a decreasing trend in adult hospitalization rates for this cause in the country (p-value < 0.001; 95%CI -0.094;-0.079) and in all its regions, for both sexes (p-value < 0.001). Conclusion: hospitalizations for mental and behavioral disorders due to alcohol use have reduced in Brazil and in its macro-regions.

Objetivo: analizar la tendencia de las tasas de hospitalizaciones por trastornos mentales y comportamentales debidos al consumo de alcohol (CID-10 F10.0) en Brasil y sus regiones, entre 2010 y 2020. Métodos: estudio de series temporales ecológicas, con datos extraídos del Sistema de Información Hospitalaria del Sistema Único de Salud. Se utilizó la regresión lineal generalizada de Prais-Winsten para calcular la tendencia de las hospitalizaciones; los análisis se realizaron con el software Stata 14.0. La tendencia se consideró descendente cuando p-valor < 0,05 y coeficiente de regresión negativo. Resultados: 423.290 hospitalizaciones ocurrieron en Brasil en el período. Los datos analizados permitieron observar una tendencia decreciente en las tasas en adultos por esta causa en Brasil (p-valor < 0,001; IC95% -0,094;-0,079) y en todas las regiones para ambos sexos (p-valor< 0,001). Conclusión: hubo una reducción en las hospitalizaciones por trastornos mentales y comportamentales debido al consumo de alcohol en Brasil y regiones.

Objetivo: analisar a tendência das taxas de internações por transtornos mentais e comportamentais devidos ao uso de álcool (CID-10: F10.0), Brasil e suas cinco regiões, 2010-2020. Métodos: estudo ecológico de série temporal, com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde; para o cálculo da tendência de internações, utilizou-se a regressão generalizada linear de Prais-Winsten e o software estatístico Stata 14.0; considerou-se tendência declinante quando p-valor < 0,05, com coeficiente da regressão negativo. Resultados: no período analisado, ocorreram 423.290 internações por transtornos mentais e comportamentais decorrentes do uso do álcool, no país; os dados analisados permitiram observar uma tendência declinante das taxas de internação de adultos por essa causa no país p-valor < 0,001; IC95% -0,094;-0,079) e em todas as suas regiões, para ambos os sexos (p-valor < 0,001). Conclusão: as internações por transtornos mentais e comportamentais devidos ao uso de álcool se reduziram, no Brasil e em suas macrorregiões.

Dental and Periodontal Conditions in Alcoholics from a Brazilian Recovery Centera

ABSTRACT: The aim of this study was to evaluate the dental and periodontal condition of alcohol-dependents from a Brazilian Recovery Center. Sixty male individuals (30 alcoholic and 30 non-alcoholic) and aged between 32 and 72 years old were clinically evaluated. Interviews, dental and periodontal clinical examinations were obtained from all participants. The Pearson Chi-Square Test and Exact Fisher test were used to compare categorical data. The t-Student's test was adopted for non-categorical data. Multiple logistic regressions were used to evaluate the association of variables in the groups. The alcoholics were younger, consumed more tobacco, had lower frequency of tooth brushing and dental flossing, higher number of missing and decayed teeth, more residual root, and more teeth with presence of visible plaque index (OR = 0.5, 95 % Cl = 4.4 to 5.5), when compared to the non-alcoholics. Alcoholics at the Recovery Center performed poor oral hygiene, had higher number of sites with periodontal disease, and worse oral hygiene than non-alcoholic individuals. As regards professional follow-up, there was similarity between the groups evaluated.

RESUMEN: El objetivo de este estudio fue evaluar las condiciones dentales y periodontales de los alcohólicos de un Centro de Recuperación de Brasil. Sesenta hombres (30 alcohólicos y 30 no alcohólicos) y con edades comprendidas entre 32 y 72 años fueron evaluados clínicamente. Se obtuvieron entrevistas, exámenes clínicos dentales y periodontales de todos los participantes. La prueba de Chi-cuadrado de Pearson y la prueba exacta de Fisher se utilizaron para comparar datos categóricos. La prueba de t-Student se adoptó para datos no categóricos. Se utilizaron regresiones logísticas múltiples para evaluar la asociación de variables en los grupos. Los alcohólicos eran más jóvenes, consumían más tabaco, tenían menor frecuencia de cepillado dental y uso de hilo dental, mayor número de dientes perdidos y cariados, más raíz residual y más dientes con presencia de índice de placa visible (OR = 0,5, 95 % Cl = 4,4 a 5,5), en comparación con los no alcohólicos. Los alcohólicos en el Centro de Recuperación realizan una mala higiene bucal, tenían un mayor número de sitios con enfermedad periodontal y una peor higiene bucal que los no alcohólicos. En cuanto al seguimiento profesional, hubo similitud entre los grupos evaluados.

Esquizofrenia asociada a consumo de múltiples sustancias. Responsabilidad profesional / Schizophrenia Associated with Multiple Substance Use

Resumen La esquizofrenia es un trastorno psiquiátrico grave clasificado dentro de los trastornos psicóticos. Los pacientes suelen presentar síntomas variables dependiendo de las 3 dimensiones sintomáticas que padezcan, lo que genera dilación en su apego temprano al tratamiento. El caso clínico de interés a presentar corresponde a un paciente del sexo masculino en la cuarta década de la vida diagnosticado con esquizofrenia asociado al consumo de múltiples sustancias, el cual fue motivo de analizar derivado de los efectos adversos presentados al tratamiento farmacológico posterior a un episodio psicótico. El abordaje farmacológico con pacientes que padecen esta patología debe ir encaminado a contrarrestar los síntomas con base en antipsicóticos y a los efectos adversos causados por los mismos, siempre y cuando la enfermedad sea diagnosticada oportunamente.

Abstract Schizophrenia is a severe psychiatric disorder classified within the psychotic disorders. Patients usually present variable symptoms depending on the three symptomatic dimensions they suffer from, which generates delay in their early adherence to treatment. The clinical case of interest to be presented corresponds to a male patient in the fourth decade of life diagnosed with schizophrenia associated with multiple substance use, which was analyzed due to the adverse effects of pharmacological treatment following a psychotic episode. The pharmacological approach with patients suffering from this pathology should be aimed at counteracting the symptoms based on antipsychotics and the adverse effects caused by them as long as the disease is diagnosed in a timely manner.

Experiences of alcohol-dependent elderly: grounded theory / Experiencias de los ancianos dependientes del alcohol: teoría fundamentada en datos / Vivências de idosos dependentes de álcool: teoria fundamentada nos dados

ABSTRACT Objective: To interpret the experiences of alcohol-dependent elderly people. Method: Qualitative research developed through the theoretical and methodological assumptions of the Grounded Theory in the Straussian version. It was carried out in a small town in the mid-western region of the state of São Paulo. The selection was by theoretical sampling, totaling 25 participants from three sample groups. Semistructured interviews were conducted from March 2019 to January 2020. Results: The phenomenon "Experiencing alcohol dependence in old age", is conditioned by the category "Initiating Alcohol Consumption", are actions/interactions "Justifying alcohol consumption" and "Coping with alcohol treatment and abstinence" whose consequences are "Experiencing the harms of alcohol dependence" and "Expressing feelings". Conclusion: It was evidenced that the elderly participants consider alcohol dependence as a way to deal with negative emotions, and, in this trajectory, they experience physical, mental, and social consequences. The elderly in abstinence express feelings of loneliness, regret, and desire for a life with quality, and indicate that behavioral change occurs through treatment and awareness of its harmful effects.

RESUMEN Objetivo: Interpretar las experiencias de las personas mayores dependientes del alcohol. Método: Investigación cualitativa desarrollada a través de los supuestos teóricos y metodológicos de la Teoría Fundamentada en Datos en su versión straussiana. Se llevó a cabo en un municipio de pequeño tamaño de la región centro-oeste del Estado de São Paulo. La selección fue por muestreo teórico, totalizando 25 participantes de tres grupos de muestra. Las entrevistas semiestructuradas se realizaron entre marzo de 2019 y enero de 2020. Resultados: El fenómeno "Experimentar la dependencia del alcohol en la vejez", está condicionado por la categoría "Iniciar el consumo de alcohol", son acciones/interacciones "Justificar el consumo de alcohol" y "Afrontar el tratamiento del alcohol y la abstinencia" cuyas consecuencias son "Experimentar el daño de la dependencia del alcohol" y "Expresar sentimientos". Conclusión: Se evidenció que los participantes de edad avanzada consideran la dependencia del alcohol como una forma de lidiar con las emociones negativas y, en esta trayectoria, experimentan consecuencias físicas, mentales y sociales. Los ancianos en abstinencia expresan sentimientos de soledad, arrepentimiento y deseo de una vida con calidad, e indican que el cambio de comportamiento se produce gracias al tratamiento y a la conciencia de sus efectos nocivos.

RESUMO Objetivo: Interpretar as vivências dos idosos dependentes de álcool. Método: Pesquisa qualitativa desenvolvida por meio dos pressupostos teórico-metodológicos da Teoria Fundamentada dos Dados na versão straussiana. Foi realizada em um município de pequeno porte da região centro-oeste paulista. A seleção foi por amostragem teórica, totalizando 25 participantes a partir de três grupos amostrais. Foram conduzidas entrevistas semiestruturadas entre março de 2019 a janeiro de 2020. Resultados: O fenômeno "Vivenciando a dependência de álcool na velhice", está condicionado pela categoria "Iniciando o consumo de Álcool", são ações/interações "Justificando o consumo de álcool" e "Enfrentando o tratamento e a abstinência do álcool" cujas consequências são "Experienciando os danos da dependência de álcool" e "Expressando sentimentos". Conclusão: Evidenciou-se que os idosos participantes consideram a dependência de álcool como forma de lidar com emoções negativas, e, nessa trajetória, experienciam consequências físicas, mentais e sociais. Os idosos em abstinência expressam sentimentos de solidão, arrependimento e desejo de uma vida com qualidade, e indicam que a mudança comportamental ocorre por meio do tratamento e conscientização de seus malefícios.

Significados do alcoolismo em uma reunião feminina de Alcoólicos Anônimos na cidade de São Paulo, SP, Brasil / Meanings of alcoholism in a women-only Alcoholics Anonymous in São Paulo, SP, Brazil / Significados del alcoholismo en una reunión femenina de Alcohólicos Anónimos en la ciudad de São Paulo, SP, Brasil

O objetivo deste artigo é compreender os significados do alcoolismo de uma maneira êmica, isto é, tal como ele é concebido e vivenciado por mulheres que frequentam uma reunião feminina de Alcoólicos Anônimos (AA). Realizou-se uma pesquisa qualitativa, de abordagem etnográfica, em uma reunião exclusiva de mulheres em um grupo localizado na cidade de São Paulo, Brasil. O alcoolismo está ligado às assimetrias de gênero, que estabelecem uma diferença entre homens e mulheres em relação ao uso de bebidas alcoólicas, de modo que a reunião feminina de AA possui uma dimensão política que se contrapõe à cultura patriarcal de AA ao garantir às mulheres um espaço de gênero, moral e politicamente, privilegiado para que elas possam compartilhar e significar suas experiências e, por essa via, realizar seu tratamento do alcoolismo.(AU)

The aim of this emic study of alcoholism was to understand how this problem is conceived and experienced by women attending a women-only Alcoholics Anonymous (AA) meeting. We conducted an ethnographic study with a women's AA group in São Paulo, Brazil. Alcoholism is linked to gender asymmetries, which establish a difference between men and women in relation to drinking. Women-only AA meetings therefore possess a political dimension that counterposes AA's patriarchal culture by providing women with a morally and politically unique gendered space that allows them to share and signify their experiences and, in this way, treat their alcoholism.(AU)

El objetivo de este artículo es comprender los significados del alcoholismo de una manera émica, es decir, tal como es concebido y vivido por mujeres que frecuentan una reunión femenina de Alcohólicos Anónimos (AA). Se realizó una investigación cualitativa, de abordaje etnográfico, en una reunión exclusiva de mujeres en un grupo localizado en la Ciudad de São Paulo, Brasil. El alcoholismo está vinculado a las asimetrías de género que establecen una diferencia entre hombres y mujeres con relación al uso de bebidas alcohólicas, de modo que la reunión femenina de AA tiene una dimensión política que se contrapone a la cultura patriarcal de AA al asegurar a las mujeres un espacio de género, moral y políticamente privilegiado para que ellas puedan compartir y significar sus experiencias y, por esa vía, realizar su tratamiento del alcoholismo.(AU)

Intervención educativa sobre alcoholismo en pobladores del policlínico Fermín Valdés Domínguez, Baracoa / Educative Intervention about Alcoholism in Residents belonging to Fermín Valdés Domínguez Polyclinic of Baracoa Municipality

Introducción: El alcoholismo es una enfermedad crónica que daña el organismo, el funcionamiento familiar y social, y puede ser causa de violencia, conductas antisociales, desavenencias familiares, accidentes e incluso homicidios. Objetivo: Evaluar la utilidad de la aplicación de un programa de intervención educativa para modificar el nivel de conocimientos sobre alcoholismo en pobladores de la comunidad de Santa Rosa. Métodos: Se realizó un estudio preexperimental de tipo antes-después. El universo del estudio estuvo compuesto por los pacientes mayores de 18 años de edad. Se seleccionó una muestra no probabilística de tipo intencional de 30 pacientes, cuya selección obedeció a los siguientes criterios de inclusión: estar aptos física y mentalmente, tener de 19 a 70 años, no tener ningún proceso mórbido invalidante y tener disposición a participar en el estudio. Resultados: Se evidenció un predominio del sexo masculino y la edad de 18 a 20 años. Antes de la intervención educativa, 76,7 por ciento no tenía conocimientos sobre las consecuencias que provoca el consumo de alcohol; luego de aplicada la intervención mejoraron notablemente estos conocimientos. Del total de encuestados, 76,6 por ciento (23) tenía un conocimiento bajo antes de la intervención educativa y después de aplicada la intervención, 86,7 por ciento se encontraban calificados con conocimiento alto. Solo un adolescente clasificó en nivel bajo. Conclusiones: Se evidenció la efectividad de la intervención educativa al aportar los conocimientos necesarios sobre temas relacionados con el alcoholismo, se propuso extender la estrategia de intervención a todos los pobladores del municipio(AU)

Introduction: Alcoholism is a chronic disease that damages the organism, as well as family and social functioning, apart from being a cause of violence, antisocial behaviors, family disagreements, accidents, and even homicides. Objective: To assess the usefulness of applying an educational intervention program to modify the level of knowledge about alcoholism in residents from the community of Santa Rosa, Baracoa Municipality, Guantánamo Province, Cuba. Methods: A preexperimental before-and-after study was carried out. The study universe was made up of patients over eighteen years of age. A nonprobabilistic purposive sample of thirty patients was selected under the following inclusion criteria: to be physically and mentally fit, to be between nineteen and seventy years old, not to have any disabling morbid process, and to be willing to participate in the study. Results: There was a predominance of the male sex and ages between eighteen and twenty years. Before the educational intervention, 76.7 percent had no knowledge about the consequences of alcohol consumption; after the intervention, this knowledge improved significantly. Of the total number of respondents, 76.6 percent (23) had a low level of knowledge before the educational intervention, while 86.7 percent were classified as having a high level of knowledge after the intervention. Only one adolescent was classified at a low level. Conclusions: The effectiveness of the educational intervention was evidenced, since it provided the necessary knowledge on topics related to alcoholism. The intervention strategy was proposed to be extended to all the inhabitants of the municipality(AU)