Alcohol pharmacotherapy dispensing trends in Australia between 2006 and 2023.

AIMS: This study aimed to investigate acamprosate and naltrexone dispensing patterns in Australia. METHODS: A 10% representative sample of medications subsidized by the Australian Pharmaceutical Benefits Scheme (PBS) was used to identify individuals who were dispensed naltrexone or acamprosate between January 2006 and December 2023. Data were used to examine concurrent dispensing, medication switching and treatment episode length, as well as changes in prevalence and incidence over time. RESULTS: During the study, we identified 22 745 individuals with a total of 117 548 dispensed prescriptions (45.3% naltrexone, 43.0% acamprosate, and 11.7% concurrent dispensing). Alcohol pharmacotherapy dispensing occurred in 1354 per 100 000 individuals. It is estimated that 2.9% of individuals with an alcohol use disorder in Australia are receiving a PBS-listed pharmacological treatment. For both pharmacotherapies, individuals were most likely to be male (60.0%) and 35-54 years of age (56.0%). Individuals were more likely to switch from acamprosate to naltrexone rather than the reverse. From 2006 and 2023, the number of prevalent individuals treated with an alcohol pharmacotherapy significantly increased, driven mainly the use of naltrexone, which more than doubled over the study period. Incident naltrexone-treated individuals were more likely to remain on treatment for the recommended minimum 3-month period compared to acamprosate treated individuals, although overall dispensing for at least 3 months was low (5.1%). CONCLUSIONS: In Australia between 2006 and 2023, rates of naltrexone dispensing have substantially increased, while acamprosate dispensing showed minimal changes. However, the use of alcohol pharmacotherapies remains low compared with the likely prevalence of alcohol use disorders.

Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework.

PURPOSE: Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS: A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS: The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS: Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.

A systematic review of interventions to enhance initiation of and adherence to treatment for alcohol use disorders.

BACKGROUND: Alcohol use disorders (AUDs) contribute significantly to the global disease burden in terms of morbidity and mortality. While effective treatment options exist, engagement with care remains a challenge, impacting treatment outcomes and resource allocation, particularly in resource-constrained settings. In this review, we aim to systematically examine and synthesize the evidence on interventions targeting initiation of and adherence to treatment for AUDs. METHODS: A search was conducted on six electronic databases (MEDLINE, PsycINFO, Embase, Global Health, CINAHL and CENTRAL) using search terms under the following concepts: alcohol use disorders, initiation/adherence, treatments, and controlled trial study design. Due to the heterogeneity in intervention content and outcomes among the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: The search yielded 32 distinct studies testing eleven categories of interventions. 23 out of 32 studies reported effectiveness of interventions in improving at least one initiation or adherence outcome, with 11 studies reporting an improvement in at least one outcome related to drinking, and four studies reporting improvements in at least one measure of well-being or disability. Community Reinforcement Approach and Family Training (CRAFT) emerged as a prominent approach for treatment initiation, contingency management for adherence, and motivational interviewing (MI) for both treatment initiation and adherence. CONCLUSION: Integrating initiation and adherence interventions into AUD treatment services holds immense potential for optimizing client outcomes and fostering overall well-being. However, generalizability of these strategies remains uncertain owing to the lack of studies conducted in low- and middle-income countries. Addressing this gap is crucial for enhancing global access to effective treatments for AUDs.

Detection of Alcoholic EEG signal using LASSO regression with metaheuristics algorithms based LSTM and enhanced artificial neural network classification algorithms.

The world has a higher count of death rates as a result of Alcohol consumption. Identification is possible because Alcoholic EEG waves have a certain behavior that is totally different compared to the non-alcoholic individual. The available approaches take longer to provide the feedback because they analyze the data manually. For this reason, in the present paper we propose a novel approach applied to detect alcoholic EEG signals automatically by using deep learning methods. Our strategy has advantages as far as fast detection is concerned; hence people can help immediately when there is a need. The potential for a significant decrease in deaths from alcohol poisoning and improvement to public health is presented by this advancement. In order to create clusters and classify the alcoholic EEG signals, this research uses a cascaded process. To begin with, an initial clustering and feature extraction is done by LASSO regression. After that, a variety of meta-heuristics algorithms like Particle Swarm Optimization (PSO), Binary Coding Harmony Search (BCHS) as well as Binary Dragonfly Algorithm (BDA) are employed for feature minimization. When this method is used, normal and alcoholic EEG signals may be differentiated using non-linear features. PSO, BCHS, and BDA features allow for estimation of statistical parameters through t-test, Friedman statistic test, Mann-Whitney U test, and Z-Score with corresponding p-values for alcoholic EEG signals. Lastly, classification is done by the use of support vector machines (SVM) (including linear, polynomial, and Gaussian kernels), random forests, artificial neural networks (ANN), enhanced artificial neural networks (EANN), and LSTM models. Results showed that LASSO regression with BDA-based EANN proposed classifier have a classification accuracy of 99.59%, indicating that our method is highly accurate at classifying alcoholic EEG signals.

Provider perceptions of young people living with HIV and unhealthy alcohol use in Southwestern Uganda: a qualitative study.

BACKGROUND: Unhealthy alcohol use is a common public health problem in HIV care settings in Africa and it affects the HIV continuum of care. In Uganda and other low-income countries, HIV care providers are a key resource in caring for young people (15-24 years) living with HIV (YPLH) with unhealthy alcohol use. Caring for YPLH largely depends on care providers' perceptions of the problem. However, data that explores HIV care providers' perceptions about caring for YPLH with unhealthy drinking are lacking in Uganda. We sought to describe the perceptions of HIV care providers regarding caring for YPLH with unhealthy drinking in the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. METHODS: We used semi-structured in-depth interviews (IDIs) to qualitatively explore HIV care providers' perceptions regarding caring for YPLH with unhealthy alcohol use. The study was conducted at the adolescent immunosuppression (ISS) clinic of Mbarara Regional Referral Hospital. Interviews were tape-recorded and transcribed verbatim. Using thematic content analysis, data from 10 interviews were analyzed. RESULTS: HIV care providers were concerned and intended to care for YPLH with unhealthy alcohol use. They understood that unhealthy drinking negatively impacts HIV care outcomes and used counseling, peer support, and referrals to routinely intervene. They however, did not apply other known interventions such as health education, medications and follow-up visits because these required family and institutional support which was largely lacking. Additional barriers that HCPs faced in caring for YPLH included; gaps in knowledge and skills required to address alcohol use in young patients, heavy workloads that hindered the provision of psychosocial interventions, late payment of and low remunerations, lack of improvement in some YPLH, and inadequate support from both their families and hospital management. CONCLUSION: HIV care providers are important stakeholders in the identification and care of YPLH with unhealthy alcohol use in Southwestern Uganda. There is a need to train and skill HCPs in unhealthy alcohol use care. Such training ought to target the attitudes, subjective norms, and perceived control of the providers.

Loss of Consciousness After Naltrexone Implantation: A Case Report. / Naltrekson Implant Uygulamasi Sonrasinda Gelisen Bilinç Kaybi: Olgu Sunumu.

Naltrexone is an µ opioid receptor antagonist that is used in alcohol and opiate use disorder. Naltrexone does not constitute tolerance and dependence, and cessation of the drug does not cause withdrawal symptoms. Sustained release form of naltrexone has been developed due to patient compliance issues. There is currently only one sustainedrelease form available in Turkey, which is inserted subcutaneously. In this case report, we present, a probable serious side effect of sustained release naltrexone implant. A 36 years old male with alcohol use disorder, developed a sudden clouding of consciousness one hour after the naltrexone implant application followed by anterograde amnesia in the next 8-10 hours. We were not able to detect any medical or neurological reasons for the altered mental status but after the removal of the naltrexone implant, the symptoms improved. To the best of our knowledge, this is the first case to report clouding of consciousness and anterograde amnesia after naltrexone implantation. Keywords: Naltrexone Implant, Side Effect, Alcohol Use Disorder, Lethargy, Consciousness.

Telemedicine for Initiation of Alcohol Use Disorder Medications.

This case-control study examines the initiation of treatment with medications for alcohol use disorder (MAUD) among US adults and compares the characteristics of adults who initiate MAUD treatment via telemedicine vs in-person care.

Emotional Impact of COVID-19 and Emotional Eating and the Risk of Alcohol Use Disorder in Peruvian Healthcare Students.

BACKGROUND: This study aimed to explore the association between the emotional impact of COVID-19 and emotional eating and the risk of alcohol use disorder among Peruvian health science students. METHODS: We conducted a cross-sectional analytical study in which an online questionnaire was administered to 456 health science interns from four cities in Peru. We used the COVID-19 Emotional Impact Profile questionnaire, Mindful Eating Questionnaire, and Alcohol Use Disorders Identification Test. Spearman's correlations were calculated and two multiple linear regression models were developed. RESULTS: 68.4% of the participants were emotional eaters and 8.6% reported low-risk levels of alcohol use disorder. Based on the results of the first model, the overall emotional impact of COVID-19, being overweight or obese, depression and anxiety levels, and living with only one parent were factors associated with emotional eating. The results of the second model showed that the level of depression, living with just one parent, living alone, sex, and number of months as an intern were factors associated with the risk of alcohol use disorder. CONCLUSIONS: To reduce emotional eating and the risk of alcohol use disorder among interns, universities should implement interventions aimed at reducing the emotional impact of COVID-19 and provide nutritional counseling.

Dangerous Intersection of Alcoholism and Othello Syndrome: A Comprehensive Review of Delusional Jealousy and Treatment Strategies.

The modern pace of life, increased susceptibility to stressors, and easy access to psychoactive substances have contributed to the increase in the number of people addicted to alcohol. Alcoholism has serious and life-threatening consequences, one of which is brain damage causing morbid jealousy, otherwise known as Othello syndrome. The disease, currently classified as a subtype of delusional disorder, manifests itself in groundless and dangerous judgments about a partner's sexual infidelity. People with Othello syndrome constantly believe in their partner's infidelity despite inadequate evidence of it. Patients become aggressive toward their partners as well as themselves, which is why in a fit of anger they can commit murder or suicide. Othello syndrome can occur as a symptom of an underlying mental illness, but it is most often associated with brain damage caused by chronic alcohol use. Antipsychotic drugs and serotonin reuptake inhibitors are used in pharmacotherapy. Targeted treatment using the neuropeptide oxytocin, which modulates the transmitter systems responsible for disease symptoms, is also being considered. The use of oxytocin seems groundbreaking, but it remains at the research stage. The treatment of addictions and primary diseases, as well as long-term cognitive-analytic psychotherapy, also have a huge impact. Othello syndrome is a life-threatening disease with an insidious course and serious consequences. This article aims to review the manifestations of morbid jealousy, including delusional disorder, and the association with alcoholism.

Naltrexone augmented with prazosin for alcohol use disorder: results from a randomized controlled proof-of-concept trial.

AIMS: We conducted a proof-of-concept randomized controlled trial of the mu-opioid receptor antagonist, naltrexone, augmented with the alpha-1 adrenergic receptor antagonist, prazosin, for alcohol use disorder in veterans. We sought a signal that the naltrexone plus prazosin combination regimen would be superior to naltrexone alone. METHODS: Thirty-one actively drinking veterans with alcohol use disorder were randomized 1:1:1:1 to naltrexone plus prazosin (NAL-PRAZ [n = 8]), naltrexone plus placebo (NAL-PLAC [n = 7]), prazosin plus placebo (PRAZ-PLAC [n = 7]), or placebo plus placebo (PLAC-PLAC [n = 9]) for 6 weeks. Prazosin was titrated over 2 weeks to a target dose of 4 mg QAM, 4 mg QPM, and 8 mg QHS. Naltrexone was administered at 50 mg QD. Primary outcomes were the Penn Alcohol Craving Scale (PACS), % drinking days (PDD), and % heavy drinking days (PHDD). RESULTS: In the NAL-PRAZ condition, % reductions from baseline for all three primary outcome measures exceeded 50% and were at least twice as large as % reductions in the NAL-PLAC condition (PACS: 57% vs. 26%; PDD: 51% vs. 22%; PHDD: 69% vs. 15%) and in the other two comparator conditions. Standardized effect sizes between NAL-PRAZ and NAL-PLAC for each primary outcome measure were >0.8. All but one participant assigned to the two prazosin containing conditions achieved the target prazosin dose of 16 mg/day and maintained that dose for the duration of the trial. CONCLUSION: These results suggest that prazosin augmentation of naltrexone enhances naltrexone benefit for alcohol use disorder. These results strengthen rationale for an adequately powered definitive randomized controlled trial.

Alcohol misuse within different socio-ecologies in rural communities of Botswana.

Alcohol-related research in Botswana has rarely used a socio-ecological approach. This article presents a phenomenological in-depth analysis drawn from community mapping interviews (n = 23) collected among community leaders and service providers in one village in Botswana. The socio-ecological approach guided our research and analysis. This paper explored the influence of alcohol misuse within the cultural, familial, practices and legal frameworks in Botswana. Findings revealed patterns in alcohol misuse over time, the influence of alcohol misuse within different ecological systems, and their response to alcohol patterns as three global themes are discussed. The findings showed that alcohol misuse remains a major public health problem that trickles down from the community, and family systems to an individual, when there are with limited resources to address the alcohol misuse that exists. Recommendations to address alcohol misuse in Botswana include providing alcohol-free recreational places, more research on alcohol harm, and educating communities about alcohol harm.

Brief intervention protocol by telephone delivered by nurses to patients with harmful alcohol use in primary health care: A feasibility trial.

AIM: The aim of this study is to examine the feasibility of a brief intervention protocol by telephone performed by nurses in primary health care facilities. METHODS: A nonrandomized single-arm feasibility study was performed. The proposed intervention of this study is the Brief Intervention carried out by the nurse delivered by telephone, synchronously with alcohol users. The brief intervention is a motivational approach based on the FRAMES model, with its components being: Feedback, Responsibility, Advice, Menu of options, Empathy and Self-efficacy. To assess the feasibility of the protocol, we evaluated the procedure for enrolling participants, the acceptability of the protocol to participants, the satisfaction of the participants, convenience and treatment continuity. The quantitative data analysis was carried out in the R software, using descriptive statistics, categorical variables were reported by frequencies and percentages. For continuous variables, medians, means, standard deviations and range values were computed. RESULTS: We followed the participants (n = 165) from baseline (T0) until 3 months (T1) and 6 months (T2) after the brief intervention. The partial effect suggests a reduction in alcohol consumption, and statistically significant differences were observed from baseline before the BI, with a decrease of 0.66 points in AUDIT scores at T1. Among the patients who completed the 3-month follow-up, 48 % reported a positive experience of receiving the brief intervention by the nurses, and 44 % reported a decrease in alcohol consumption. CONCLUSIONS: Brief intervention delivered by telephone was considered feasible and acceptable by primary health care patients, and they perceived improvement in their alcohol consumption after receiving the BI performed by nurses.

Exploring barriers and facilitators to addressing hazardous alcohol use and AUD in mental health services: a qualitative study among Dutch professionals.

BACKGROUND: Hazardous alcohol use and alcohol use disorder (AUD) are highly prevalent among clients in mental health services, yet significant gaps remain in the adequate assessment of alcohol use and provision of appropriate alcohol interventions. The aim of this study was to conduct an exploration of (i) alcohol intervention elements used in mental health services and (ii) professionals' reported barriers and facilitators in identifying and intervening with hazardous alcohol use and AUD. METHODS: Qualitative data were obtained by conducting semi-structured interviews among a purposive sample of 18 professionals from 13 different Dutch mental health services organizations (i.e., five integrated mental health organizations with addiction services, five mental health organizations without addiction services, and three addiction services organizations without mental health services). Transcripts were qualitatively analyzed using inductive thematic analysis. RESULTS: Identified alcohol intervention elements included conducting assessments, brief interventions, treatment, referrals of clients, collaborations with other parties, and providing information to professionals. Professionals mentioned nine barriers and facilitators in the identification and intervention with hazardous alcohol use and AUD, including three aspects of professionals' behavior (i.e., professionals' agenda setting, knowledge and skills, and attitudes), actions related to identification and intervening, client contact, collaboration with other parties, and three factors in a wider context (i.e., organizational characteristics, organizational resources, and governmental aspects). CONCLUSIONS: Although diverse alcohol intervention elements are available in Dutch mental health services, it remains unclear to what extent these are routinely implemented. To better address hazardous alcohol use and AUD in mental health services, efforts should focus on enhancing alcohol training, improving collaboration with addiction services, providing appropriate tools, and facilitating support through organizational and governmental measures.

Identification of gene co-expression modules from zebrafish brain data: Applications in psychiatry illustrated through alcohol-related traits.

Cumulative evidence suggests that zebrafish is a useful model in psychiatric research. Weighted Gene Co-expression Network Analysis (WGCNA) enables the reduction of genome-wide expression data to modules of highly co-expressed genes, which are hypothesized to interact within molecular networks. In this study, we first applied WGCNA to zebrafish brain expression data across different experimental conditions. Then, we characterized the different co-expression modules by gene-set enrichment analysis and hub gene-phenotype association. Finally, we analyzed association of polygenic risk scores (PRSs) based on genes of some interesting co-expression modules with alcohol dependence in 524 patients and 729 controls from Galicia, using competitive tests. Our approach revealed 34 co-expression modules in the zebrafish brain, with some showing enrichment in human synaptic genes, brain tissues, or brain developmental stages. Moreover, certain co-expression modules were enriched in psychiatry-related GWAS and comprised hub genes associated with psychiatry-related traits in both human GWAS and zebrafish models. Expression patterns of some co-expression modules were associated with the tested experimental conditions, mainly with substance withdrawal and cold stress. Notably, a PRS based on genes from co-expression modules exclusively associated with substance withdrawal in zebrafish showed a stronger association with human alcohol dependence than PRSs based on randomly selected brain-expressed genes. In conclusion, our analysis led to the identification of co-expressed gene modules that may model human brain gene networks involved in psychiatry-related traits. Specifically, we detected a cluster of co-expressed genes whose expression was exclusively associated with substance withdrawal in zebrafish, which significantly contributed to alcohol dependence susceptibility in humans.

Integrated telehealth intervention to reduce chronic pain and unhealthy drinking among people living with HIV: protocol for a randomized controlled trial.

BACKGROUND: Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). METHODS: Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. CONCLUSION: This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. GOV IDENTIFIER: NCT05503173.

THE INFLUENCE OF CHANGES IN CARBOHYDRATE METABOLISM INDICATORS IN PATIENTS WITH POLYTRAUMA COMPLICATED BY ALCOHOLIC DELIRIUM ON THE CHOICE OF THE SEDATION METHOD.

Topicality: Providing assistance to patients with polytrauma, in a state of alcohol intoxication, complicated by alcoholic delirium, is a serious problem when providing anesthesia care and, in particular, choosing drugs for sedation. Considering the severity of mechanical damage, complications associated with alcohol intoxication and serious biochemical disorders of the body, namely carbohydrate, lipid metabolism, electrolyte changes, on which the activity of all systems depends, it is necessary to study the influence on the course of these processes, depending on the choice of their medicinal corrections. PURPOSE: The purpose of the work is to choose a sedation method to improve the results of treatment of patients with polytrauma and alcohol withdrawal, based on the study of changes in carbohydrate metabolism indicator. MATERIALS AND METHODS: The paper analyzes the results of a study of 80 patients with polytrauma and chronic alcohol intoxication with a state of alcohol withdrawal, complicated by alcoholic delirium, who received intensive therapy in the 12-bed department of anesthesiology and intensive therapy for patients with combined trauma of the KNP «Kharkiv City Clinical Hospital of Emergency Medical Care¼ named after Prof. O. I. Meschaninov¼ KhMR. All patients were diagnosed with polytrauma (thoracic and/or abdominal trauma: rib fractures, hemo-, pneumothorax, hematomas of the liver or spleen, fracture of the bones of the waist, and/or upper and/or lower limbs, fracture of the pelvis). In the course of the research, to achieve the goal, the main indicators of carbohydrate metabolism were determined, which were evaluated by the content of key metabolites: glucose, pyruvic acid, lactate. The study was conducted on the 1st, 3rd and 7th day of hospitalization of the patients. RESULTS AND DISCUSSION: In all traumatized patients with alcohol withdrawal syndrome and alcoholic delirium with the use of dexmedetomidine for sedation (group 1) and in patients who were used as sedatives, diazepam and haloperidol (group 2), changes in these parameters were observed in the blood, compared to healthy people of the control group. As for the glucose content in the blood of the patients of the 1st group, on the first day, persistent hyperglycemia was observed in them 1.7 times higher than this indicator in healthy people. Next, patients' blood glucose levels were determined on the 3rd and 7th day after hospitalization. Glucose content on the 3rd day decreased by 9.4% compared to the level determined on the first day. On the 7th day, the content of glucose in the blood decreased to normal values, which is 26.5% lower compared to the content of glucose in the blood on the first day. In the 2nd group of patients, where diazepam and haloperidol were used on the first day, hyperglycemia was also observed - 1.9 times higher than this indicator in the control group of healthy individuals. On the third day, the level of glucose in the blood decreased by 6%. And on the 7th day, it decreased by 20.5%. Thus, hyperglycemia was observed in the blood of victims with alcohol withdrawal syndrome, complicated by delirium during hospitalization, on the 3rd day of hospitalization (first and second groups) and on the 7th day in patients of the second group, which indicates violation of carbohydrate metabolism and the development of hypoxia, with impaired liver and pancreas function. In accordance with the aim and objectives of the study, the blood content of the main metabolites of glucose metabolism - pyruvate and lactate - was also studied upon admission to the hospital and one week after treatment, which made it possible to comprehensively assess possible carbohydrate metabolism disorders and characterize the features of the body's energy supply in the combination of polytrauma and withdrawal alcohol, complicated by alcoholic delirium. According to the results of the research, there is an increase in the content of lactate and pyruvate in patients with polytrauma against the background of chronic alcoholism compared to healthy people. When analyzing the content of lactate in the blood of patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium upon admission to the intensive care unit, a significant increase of this indicator was observed by 97.1% and 113.0%, respectively, in patients of the first and second groups. One week after the intensive therapy, the patients of the 1st group had a significant decrease in the lactate content in the blood - by 13% (Р<0.0001) compared to the content of this indicator at the time of admission to the hospital. In the blood of the patients of the 2nd group, on the 7th day, the lactate content remained unchanged, and by 106.3% it exceeded this biochemical indicator in the blood of the control group. Hyperpyruvatemia was also observed - when entering the hospital in patients of the 2nd group, the content was 55.4% higher compared to healthy people, remained elevated after a week of treatment - by 30.1%, and did not return to normal values. In the patients of the first group, upon admission to the hospital, the pyruvate content in the blood was 53.0% higher compared to the control group, and on the 7th day it significantly decreased by 18.9%, but did not reach the values of the control group (remained at 24, 1% higher compared to the control). The cause of hyperpyruvatemia and hyperlactatemia in patients may also be a violation of their enzymatic transformation into decay products. Lactate is the final product of anaerobic oxidation of glucose, it is formed due to the transformation of pyruvate, under the conditions of action of the lactate dehydrogenase enzyme in conditions of hypoxia. An important indicator of the state of carbohydrate metabolism, namely the balance of anaerobic and aerobic processes in the body, is the lactate / pyruvate ratio, which in the control group was 14.33 [13.82; 14.49]. In the patients of the first group, an increase in this ratio was observed - and it was 18.46 [18.3; 20.59] and 19.81 [18.96; 21,17] upon admission to the intensive care unit and one week after treatment, respectively. Practically the same value of this ratio was observed in patients of the second group - 19.65 [18.97; 22.3] and 22.73 [21.32 23.91], respectively, according to the time of intensive therapy. The latest figures indicate the restructuring of the energy supply of body tissues during the stay of patients in the intensive care unit. CONCLUSIONS: Thus, in patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium, there is an intensification of the processes of anaerobic glycolysis, which is evidenced by an increase in the content of pyruvate, lactate, the lactate/pyruvate ratio, and is accompanied by a hypoxic state. When comparing the terms of stay in the intensive care unit, it was determined that the use of dexmedetomidine for the treatment of alcoholic delirium compared to benzodiazepines allows reducing the time of intensive care by 34 hours. Thus, in group 2, the duration of intensive therapy for alcoholic delirium was 89 [82-96.2] hours, while in group 1 it was reduced to 55 [52.2-59.8] (p=0.020427). In addition, it was found that the consumption of drugs by patients was different. During the first day, it was 20 [20-30] mg in group 1, and 40 [40-50] mg in group 2. The groups also differed significantly in terms of the total dose of the drug during intensive therapy, so in patients of group 1, the total consumption was 30 [30-40] mg, in group 2 - 80 [80-90] mg (p=0.033011).

SMSs as an alternative to provider-delivered care for unhealthy alcohol use: study protocol for Leseli, an open-label randomised controlled trial of mhGAP-Remote vs mhGAP-Standard in Lesotho.

BACKGROUND: The World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) is a validated intervention that can be provided by non-specialised healthcare workers to individuals with unhealthy alcohol use. However, it typically requires several in-person sessions at a health facility, which may limit its feasibility and effectiveness in remote settings. This trial compares mhGAP-Standard, a 4 to 6 in-person session intervention, to mhGAP-Remote, a 1 in-person session intervention followed by 8 week of short message service (SMS) in Lesotho. We hypothesise that mhGAP-Remote is superior to mhGAP-Standard in reducing alcohol use (as detailed by the primary and secondary outcomes below). METHODS: This is a two-arm randomised open-label multicentre superiority trial. Participants allocated to mhGAP-Standard receive 4 in-person sessions using motivational interviewing, identifying triggers, and alternative behaviours, with the option of two additional booster sessions. Participants in the mhGAP-Remote arm receive 1 in-person session covering the same content, followed by standardised SMSs over 8 weeks that reinforce intervention content. Non-specialist providers deliver the intervention and receive weekly supervision. Adults (Nplanned = 248) attending participating health facilities for any reason and who meet criteria for unhealthy alcohol use based on the Alcohol Use Disorders Identification Test ([AUDIT] score ≥ 6 for women, ≥ 8 for men) are individually randomised to the two arms (1:1 allocation, stratified by participant sex and age (≥ 50 vs < 50 years old). Follow-up assessments occur at 8, 20, and 32 weeks post-randomisation. The primary outcome is change in self-reported alcohol use (continuous AUDIT score), from baseline to 8 weeks follow-up. Change in the AUDIT from baseline to 20 and 32 weeks follow-up is a secondary outcome. Change in the biomarker phosphatidylethanol (secondary), liver enzyme values in serum (exploratory), and HIV viral load (for people with HIV only; exploratory) are also evaluated from baseline throughout the entire follow-up period. A linear regression model will be conducted for the primary analysis, adjusted for the stratification factors. Three a priori sensitivity analyses for the primary outcome are planned based on per protocol treatment attendance, recovery from unhealthy alcohol use, and clinically significant and reliable change. DISCUSSION: This trial will provide insight into feasibility and effectiveness of a shortened and primarily SMS supported version of mhGAP, which is especially relevant for settings where regular clinic attendance is a major barrier. TRIAL REGISTRATION: clinicaltrials.gov NCT05925270 . Approved on June 29th, 2023.

Alcohol use disorder is associated with a lower risk of in-hospital mortality in type A aortic dissection repair: a population-based study of National Inpatient Sample from 2015-2020.

BACKGROUND: While alcohol consumption is implicated in the development of aortic dissection, the impact of alcohol use disorder (AUD) on the outcomes of type A aortic dissection (TAAD) repair is still largely unexplored. This study aimed to conduct a comprehensive, population-based analysis of effect of AUD on in-hospital outcomes following TAAD repair using National/Nationwide Inpatient Sample, the largest all-payer database in the United States. METHODS: Patients undergoing TAAD repair were identified in National/Nationwide Inpatient Sample from Q4 2015-2020. Demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status between patients with and without AUD were matched by a 1:3 propensity-score matching. In-hospital outcomes were examined. RESULTS: There were 220 patients with AUD who underwent TAAD repair. Meanwhile, 4062 non-AUD patients went under TAAD repair, where 646 of them were matched to all AUD patients. After propensity-score matching, AUD patients had a lower risk of in-hospital mortality (7.76% vs 13.31%, P = 0.03) while there was no difference in transfer-in status or time from admission to operation. However, patients with AUD had a higher rate of respiratory complications (27.40% vs 19.66%, P = 0.02) and a longer hospital length of stay (16.20 ± 11.61 vs 11.72 ± 1.69 days, P = 0.01). All other in-hospital outcomes were comparable between AUD and non-AUD patients. CONCLUSION: AUD patients had a lower risk of in-hospital mortality but a higher rate of respiratory complications and a longer LOS. These findings can provide insights into preoperative risk stratification of these patients. Nonetheless, reasons underlying the lower mortality rate in AUD patients and their long-term prognosis require further investigation.

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O alcoolismo é uma doença crônica e precisa ser tratada | Coisa de Homem

Em 20 de fevereiro se comemora o Dia Nacional de Combate às Drogas e Alcoolismo, e você precisa ser embaixador dessa causa. Os CAPS Álcool e Drogas são as unidades de saúde referenciadas para tratar problemas de dependência.