The impact of frailty on intra-hospital survival in older patients with COVID-19 infection: the importance of early identification. SEMI-COVID National Registry.

BACKGROUND: Emerging evidence suggests that frailty may be a significant predictor of poor outcomes in older individuals hospitalized due to COVID-19. This study aims to determine the prognostic value of frailty on intrahospital patient survival. METHODS: This observational, multicenter, nationwide study included patients aged 70 years and older who were hospitalized due to COVID-19 in Spain between March 1 and December 31, 2020. Patient data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine. Frailty was assessed using the Clinical Frailty Scale. The primary outcome was hospital survival. Cox proportional hazards models were used to assess predictors of survival. RESULTS: A total of 1,878 participants (52% men and 48% women) were included, with 1,351 (71.9%) survivors and 527 (28.1%) non-survivors. The non-survivor group had higher mean age (83.5 vs. 81 years), comorbidities (6.3 vs. 5.3 points on the Charlson index), degree of dependency (26.8% vs. 12.4% severely dependent patients), and frailty (34.5% vs. 14.7% severely frail patients) compared to survivors. However, there were no differences in terms of sex. Our results demonstrate that a moderate-severe degree of frailty is the primary factor independently associated with shorter survival [HR 2.344 (1.437-3.823; p<0.001) for CFS 5-6 and 3.694 (2.155-6.330; p<0.001) for CFS 7-9]. CONCLUSION: Frailty is the main predictor of adverse outcomes in older patients with COVID-19. The utilization of tools such as the Clinical Frailty Scale is crucial for early detection in this population.

Patterns of food avoidance in chronic fatigue syndrome: is there a case for dietary recommendations?

OBJECTIVES: To assess the dietary habits and food avoidance-behavior in patients with Chronic Fatigue Syndrome (CFS). METHODS: Cross-sectional pilot study with 28 patients diagnosed with severe CFS. Eating habits were assessed with a food frequency questionnaire and 3-day food records. We analyzed variables related to dietary restrictions induced by symptoms or external information. RESULTS: The most prevalent restrictions were for dairy products and gluten-containing grains, with 22 and 15 restricting patients, respectively. Patients reported different digestive symptoms, which did not improve with the use of exclusion diets. Thirteen patients had received information against the intake of certain foods through different sources. Six cases of grains restriction and 11 of dairy were compatible with a counseling-induced pattern of exclusion. CONCLUSIONS: There is not a homogeneous pattern of food avoidance. Dietary restrictions should be based on a proven food allergy or intolerance. Dietary counseling should be based on sound nutritional knowledge.

Growth hormone treatment for sustained pain reduction and improvement in quality of life in severe fibromyalgia.

Functional defects in growth hormone (GH) secretion and its efficacy as a complementary treatment have been suggested for fibromyalgia. This study investigated the efficacy and safety of low-dose GH as an add-on therapy in patients with both severe FM and low insulin-like growth factor 1 levels. A total of 120 patients were enrolled in a multicenter, placebo-controlled study for 18 months. They were randomly assigned to receive either 0.006 mg/kg/day of GH subcutaneously (group A, n=60) or placebo (group B, n=60) for 6 months (blind phase). The placebo arm was switched to GH treatment from month 6 to month 12 (open phase), and a follow-up period after GH discontinuation was performed until month 18. Standard treatment for fibromyalgia (selective serotonin re-uptake inhibitors, opioids, and amitriptyline) was maintained throughout the study. Number and intensity of tender points, Fibromyalgia Impact Questionnaire (FIQ) with its subscales, and EuroQol 5 dimensions test (EQ5D) with visual analogue scale (VAS) were assessed at different time points. At the end of the study, 53% of group A patients obtained fewer than 11 positive tender points, vs 33% of group B patients (P<.05). 39.1% vs 22.4% reached more than 50% improvement in VAS (P<.05). Group A patients showed significantly improved FIQ scores (P=.01) compared with group B. Although GH discontinuation worsened all scores in both groups during follow-up, impairment in pain perception was less pronounced in the GH-treated group (P=.05). In this largest and longest placebo-controlled trial performed in FM (NCT00933686), addition of GH to the standard treatment is effective in reducing pain, showing sustained action over time.

Patterns of food avoidance in chronic fatigue syndrome; is there a case for dietary recommendations? / Patrones de evitación alimenticia en el síndrome de fatiga crónica; ¿hay base para dar recomendaciones dietéticas?

Objectives: To assess the dietary habits and food avoidance-behavior in patients with Chronic Fatigue Syndrome (CFS). Methods: Cross-sectional pilot study with 28 patients diagnosed with severe CFS. Eating habits were assessed with a food frequency questionnaire and 3-day food records. We analyzed variables related to dietary restrictions induced by symptoms or external information. Results: The most prevalent restrictions were for dairy products and gluten-containing grains, with 22 and 15 restricting patients, respectively. Patients reported different digestive symptoms, which did not improve with the use of exclusion diets. Thirteen patients had received information against the intake of certain foods through different sources. Six cases of grains restriction and 11 of dairy were compatible with a counseling-induced pattern of exclusion. Conclusions: There is not a homogeneous pattern of food avoidance. Dietary restrictions should be based on a proven food allergy or intolerance. Dietary counseling should be based on sound nutritional knowledge (AU)

Objetivos: Valorar los hábitos dietéticos y la conducta de evitación alimenticia en pacientes con Síndrome de Fatiga Crónica. Métodos: Estudio piloto transversal con 28 pacientes diagnosticados de Síndrome de Fatiga Crónica en grado severo. Los hábitos alimenticios se evaluaron mediante un cuestionario de frecuencia de consumo y registros dietéticos de 3 días. Se analizaron variables relacionadas con las restricciones dietéticas inducidas por síntomas o información externa. Resultados: Las restricciones más frecuentes fueron para los productos lácteos y cereales con gluten, con 22 y 15 pacientes que los restringían, respectivamente. Los pacientes informaron de diferentes síntomas digestivos, que no mejoraron con el uso de dietas de exclusión. Trece pacientes habían recibido información contraria al consumo de ciertos alimentos, a través de diferentes fuentes. Seis casos de restricción de cereales y 11 de lácteos fueron compatibles con un patrón de exclusión inducido por consejo. Conclusiones: No hay un patrón homogéneo de evitación alimenticia. Las restricciones dietéticas deberían basarse en una alergia o intolerancia alimentaria probada. El consejo dietético debería basarse en el conocimiento nutricional fundamentado (AU)

High prevalence of growth hormone deficiency in severe fibromyalgia syndromes.

CONTEXT: Fibromyalgia (FM) is characterized by widespread pain and fatigue and is considered a syndrome with different pathogenic mechanisms. Controversial data on GH axis disturbances have been published. Some preliminary trials have shown promising effects of GH therapy on tender points and quality of life in FM. AIM: The aim was to study the patterns of GH secretion/sensitivity in a cohort of severe FM patients. SETTING: The study was conducted in five tertiary hospitals. METHODS: A total of 493 FM women (1990 American College of Rheumatology criteria) recruited from five centers, having more than 16 tender points, Fibromyalgia Impact Questionnaire scores above 75, more than 1 yr of stable medication (serotonin reuptake inhibitors, amitriptyline, and opioids), and body mass index below 35 kg/m(2) underwent baseline IGF-I/GH determinations; an insulin tolerance test (ITT) and a modified IGF-I generation test were performed in those cases showing IGF-I of 150 microg/liter or less. RESULTS: A total of 169 of the 493 patients (34.2%) showed IGF-I of 150 microg/liter or less. Mean peak GH during ITT was 13.3 +/- 9.9 ng/ml in 127 patients in which the test was performed. In 22 of 127 (17.3%), ITT peak GH was 5 microg/ml or less, and in eight of them (6.3%), the peak GH was 3 ng/ml or less. Mean baseline GH (n = 127) was 1.47 +/- 2.58 ng/dl, and eight of 120 (6.8%) showed an insufficient IGF-I response (<50% over baseline) to the IGF-I generation test. CONCLUSION: FM patients show a high prevalence of GH axis dysfunction. A significant number of patients show biochemical patterns of GH deficiency as well as some degree of GH resistance and might be potential candidates for substitution treatment.

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Estudio de los factores que influyen en la seguridad del paciente ingresado en Medicina Interna / Stuy of the fctos that influence the safety of patients admittd to Internal Medicine

La seguridad delpaciente e la asitencia sanitaria es un factor esencial de caldad y un derecho. También está considerada como una de las principales prioridades del Plan de Calidad del Sisteman Nacional de Salud. Los objetivos de este trabajo son la evaluación de los factores que más inciden en la seguridad el pciente ingresado en un Área de Medicina Interna. El análisis de las complicaciones más frecuntes durante elireso; también se incluyen consecutivamente 100 pacientes en dos nidades de Medicina Interna, durante dos periodos diferentes y con un ingreso de más de 24 horas. Se evaluaron 16 parámetros distintos relacionados con la seguriad incluyendo identificación del paciente, comunicación con sus familiares, efectos adversos, parámetros de calidad asitencial y pautas de información. Se objetivan diversos problemas relacionados cn la seguridad asitencial en una cuarta parte de pacientes ingresados en un Área de Medicina Interna. Consideramos que se podría disminuir la incidencia de efectos adversos y otras cmplicaciones identificando sus causas desarrollando métodos que ayuden a prevenirlos o reducir sus efectos (AU)

Patient safety in health care is an essential factor in qality, and a right. It is also considered one of the main priorities of the Quality Plan of the National Health System. This paper objecties various problems in relation to healthcare sfety in a quarter of patients admited to an area of internal medicien. It is considered thattheincience of adverse effects and other complications could be reduced by identifying their causes and developing methods t help revent or reduce their effects (AU)

Valoración del ruido nocturno en Unidades de Hospitalización de un Área de Medicina / Evaluation of night-time noise in Hospital Units in a Medicine Department

El ruido nocturno es causa de molestia en pacientes ingresados, destacando en las encuestas de opinión respecto de la calidad de la asistencia recibida en la estancia en el Hospital. Este artículo analiza las causas de insatisfacción del usuario respecto a la presentcia y tipo de ruido nocturno en las instalaciones del ICMIDER (AU)

Night-time noise disturbs hospitalized patients; this is what the opinion surveys reveal about the quality of care received during their stay in the Hospital. This article analyses the causes of user dissatisfaction with the presence and type of night-time noise in the ICMIDER facilities (AU)

Secuelas neurológicas irreversibles causadas por una exposición al sulfuro de hidrógeno en un accidente laboral / Irreversible neurological sequelae caused by exposure to hydrogen sulfide in an occupational accident

Un varón de 49 años de edad presentó una intoxicación aguda por sulfuro de hidrógeno mientras realizaba tareas de mantenimiento en una industria de refinado de hidrocarburos, sin utilizar ningún tipo de equipo de protección individual. A los seis meses de la intoxicación presenta secuelas neurológicas irreversibles de tipo cerebeloso y cognitivo, reuniendo además criterios diagnósticos del síndrome de fatiga crónica. El paciente ha quedado en una situación de invalidez absoluta para cualquier tipo de actividad laboral. Se destacan los aspectos preventivos de las intoxicaciones por sulfuro de hidrógeno, ya que ocasionan un número elevado de casos mortales y los pacientes que sobreviven pueden quedar con secuelas neurológicas irreversibles(AU)

A 49-year-old male presented acute hydrogen sulfide poisoning while carrying out maintenance work without any type of protective equipment in a hydrocarbon refining plant. Six months after the poisoning, the patient presents irreversible cerebellar and cognitive neurological sequelae and also fulfils the criteria for diagnosis of chronic fatigue syndrome. He has been declared permanently work-disabled. We stress the importance of preventive measures against hydrogen sulfide poisonings, a large percentage of which result in death, with surviving patients often suffering irreversible neurological sequelae(AU)

Evaluación de parámetros de calidad de vida y repercusión funcional en pacientes con Síndrome de Fatiga Crónica / Evaluation of health related quality of life and functional impairment parameters in patients with chronic fatigue syndrome

Fundamento: El Síndrome de Fatiga Crónica (SFC) es una enfermedad claramente invalidante que altera la calidad de vida y tiene una marcada repercusión funcional en los pacientes. Objetivos: En pacientes con SFC, valorar: 1)Parámetros de Calidad de Vida Relacionada con la Salud (CVRS) y Repercusión funcional (RF), 2) Grado de afectación con una escala clínica funcional. 3) Presencia e influencia de comorbilidad asociada y 4) Relación de los parámetros de CVRS y RF con los valores poblacionales de referencia (VPR) y con los de un grupo de pacientes de similar edad afectos de artritis reumatoide (AR). Metodología: Trabajo descriptivo transversal con inclusión consecutiva de 100 pacientes afectos de SFC. 1) Estudio de datos epidemiológicos y de situación laboral. 2) Valoración de grado de afectación del SFC en una escala clínica de afectación progresiva (grados I a IV). 3) Valoración de comorbilidades: Fibromialgia, Síndrome seco, Obesidad, Distimia, Disfunción tiroidal, Colon irritable y Endometriosis 4) Valoración de CVRS con el cuestionario genérico validado Medical Outcomes Study Short-Form (SF-36) y de la RF con el cuestionario específico validado Standford Health Assessment Questionnaire (HAQ). 5) Comparación de resultados con VPR y con pacientes afectos de AR. Resultados y conclusiones: El grado de afectación funcional era moderado (II) en la mitad de casos, y leve (I) o grave (III-IV) en un 25% de casos, respectivamente. Existían alteraciones valorables en los índices de puntuación de todas las dimensiones del cuestionario HAQ. En los pacientes con SFC existía una mayor afectación de parámetros de CVRS (SF-36) en comparación tanto con parámetros poblacionales como con pacientes con AR. Las dimensiones más relacionadas con el empeoramiento funcional fueron la Función física, el Rol físico, la Vitalidad, la Función Social y el Rol emocional. Existía una correlación positiva entre la escala clínica de afectación funcional y la mayoría de dimensiones del SF- 36. El índice de incapacidad funcional medida con el HAQ presentaba una alta correlación con las puntuaciones de la dimensión función física del SF-36 y de la dimensión dolor corporal. Se objetivó una media de 2,4 tipos diferentes de co-morbilidad en cada paciente con SFC, existiendo una correlación inversa con las dimensiones de CVRS. Conclusiones: En pacientes con SFC existe una marcada afectación de los parámetros de CVRS y RF, superior a los parámetros poblacionales e incluso a los de pacientes afectos de AR. La presencia de comorbilidad supone un mayor empeoramiento funcional. El empleo de una escala clínica de afectación progresiva es útil en la valoración funcional de estos pacientes. Para mejorar potencialmente la CVRS en pacientes con SFC deberá incidirse en modificar las dimensiones afectadas, sobre todo la función física, el dolor corporal y el tratamiento de las comorbilidades

Background: Chronic Fatigue Syndrome is a disabling disease that modifies the quality of life and supposes a marked functional impairment of patients. Aim of Study: In patients with CFS, to evaluate: 1) Health-related quality of life (HRQL) and Functional impairment (FI) parameters, 2) Gradation of FI with a clinical scale. 3) Presence and influence of comorbidity related to CFS, and 4) Relationship between HRQL and FI parameters in CFS with standard population values, and with values form a group of patients of similar age affected of Rheumatoid Arthritis (RA). Patients and Methods: Cross-sectional study with consecutive inclusion of 100 patients affected of CFS. Evaluation of: 1) Epidemiological data and work situation at diagnosis. 2) Function impairment evaluation with a clinical scale of progressive involvement (degrees I to IV). 3) Evaluation of comorbilities: Fibromyalgia, Sicca Syndrome, Obesity, Dysthymia, Thyroid dysfunction, Irritable Bowel Syndrome and Endometriosis 4) Evaluation of HRQL with the validated Medical Outcomes Study Short-Form (SF-36) questionnaire and evaluation of FI with the specific Standford Health Assessment Questionnaire (HAQ). 5) Comparison of results in CFS with those of general population and also with patients affected of RA. Results: In CFS, the functional impairment was moderate (II) in half of patients, and slight (I) or severe (III-IV) in a quarter, respectively. All dimensions of HAQ questionnaire were affected. HRQL parameters measured with SF-36 questionnaire were more affected in patients with CFS as compared to standard population values as well as in comparison to patients affected of RA. The dimensions mainly related to FI were physical function, physical role, vitality, social function and emotional role. There was a direct relationship between the clinical functional scale and most of the SF-36 dimensions. The function disability index measured by HAQ highly related with values of physical role and body pain from SF-36 questionnaire. Patients with CFS presented a mean of 2.4 different types of comorbidity, with an inverse relationship with HRQL dimensions. Conclusions: In patients with CFS there is a clear decrease of HRQL and FI parameters, with significantly lower values as compared to standard population and also to patients with RA. The presence of co morbidity supposes a major degree in functional disability. A clinical scale evaluating progressive degree of involvements was useful in the functional evaluation of patients with CFS. To potentially improve the HRQL and FI in patients with CFS we should address to modify those dimensions clearly affected, mainly physical function, body pain as well as treatment of comorbidities

Consumo de alcohol y riesgo cardiovascular / Alcohol consumption and cardiovascular risk

El consumo de alcohol tiene un comportamiento ambivalente sobre el sistema cardiovascular con efectos tanto beneficiosos como nocivos. Recientemente han aparecido numerosos estudios científicos que observan un efecto beneficioso de la ingesta de dosis bajas de alcohol respecto a la disminución de la mortalidad total y mortalidad cardiovascular, menor incidencia de eventos coronarios, disminución de accidentes vasculares isquémicos cerebrales o periféricos, e incluso mejor evolución de la insuficiencia cardíaca. El análisis de estos trabajos no es sencillo por su heterogeneidad, pero cabe tener en cuenta que la mayoría de estas evidencias están basadas en estudios epidemiológicos o poblacionales, no en estudios clínicos controlados. Por ello, esta evidencia no se puede considerar como definitiva. Por otra parte, cuando se consume alcohol a altas dosis se pierden la mayoría de estos efectos beneficiosos. En esta situación aparecen los efectos nocivos del alcohol sobre el sistema cardiovascular (arritmias, hipertensión arterial, miocardiopatía alcohólica) o también sobre otros órganos como el hígado, el cerebro o una mayor incidencia de neoplasias. Cabe considerar también los efectos colaterales del consumo de alcohol como el riesgo de adicción, o los accidentes laborales o de tráfico, situaciones que no siempre están en relación con la dosis de alcohol consumida. Por ello es aconsejable evitar el consumo de dosis altas de alcohol y en ningún caso potenciar su consumo en pacientes previamente abstemios. En pacientes con consumo previo de alcohol y elevado riesgo cardiovascular se podría discutir la indicación específica de mantener un consumo controlado de dosis moderadas con una valoración personal del riesgo frente al beneficio. En esta revisión se discute el amplio espectro de efectos beneficiosos y perjudiciales que el consumo de alcohol tiene sobre el sistema cardiovascular, su patogenia y las pautas de conducta a adoptar respecto a la situación de riesgo cardiovascular

Alcohol consumption has an ambivalent behavior on the cardiovascular system, with both beneficial and harmful effects. Recently, there are many scientific studies that observe a beneficial effect of intake of low alcohol doses regarding decrease in total mortality and cardiovascular mortality, lower incidence of coronary events, decrease of ischemic cerebral or peripheral vascular accidents and even improved evolution of cardiac failure. Analysis of these studies is not easy, due to heterogeneity, but it should be kept in mind that most of this evidence is based on epidemiological or populational studies, and not on controlled clinical studies. Thus, this evidence cannot be considered as final. On the other hand, when alcohol is consumed at high doses, most of the beneficial effects are lost. In this situation, there are harmful effects of alcohol on the cardiovascular system (arrithymias, high blood pressure, alcoholic cardiomyopathy), or also on other organs such as the liver and brain or a greater incidence of neoplasias. Other side effects of alcohol consumption may also be considered: there are, for example, risk of addiction or work or traffic accident, situations that are not always related to the alcohol dose consumed. Thus, high doses of alcohol should be avoided and its consumption should never being encouraged in previously non-drinking patients. In patients with previous alcohol consumption and high cardiovascular risk, the specific indication of maintaining a controlled consumption at moderate doses with a personal assessment of risk versus benefit could be discussed. In this review, the wide spectrum of beneficial and harmful effects that alcohol consumption has on the cardiovascular system, its pathogeny and behavior guidelines to adopt regarding the cardiovascular risk situation are discussed

Síndrome de fatiga crónica y su relación con la fibromialgia / Chronic fatigue syndrome and its relationship with fibromyalgia

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Differential effects of moderate or heavy alcohol consumption on circulating adhesion molecule levels.

Epidemiological studies suggest that moderate but not heavy alcohol consumption provides protection against coronary heart disease. We assessed the relationship between alcohol consumption and serum levels of adhesion molecules involved in the pathogenesis of early atherosclerosis. One-hundred apparently healthy men with similar cardiovascular risk factors were divided into four groups according to ethanol intake. Moderate drinkers (20-40 g/day) showed lower serum intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels than abstainers (p < 0.05; both), as well as lower serum ICAM-1, VCAM-1 and E-selectin levels than heavy drinkers (p = 0.01; all). The latter also showed higher serum ICAM-1 and E-selectin levels than abstainers (p < 0.001; both). We conclude that moderate drinkers show a significant reduction of soluble endothelial adhesion molecule levels compared to abstainers and heavy drinkers, that may contribute to the protective effect of moderate alcohol consumption against atherosclerosis.

El síndrome de fatiga crónica

El síndrome de fatiga crónica refleja una situación de fatigabilidad persistente e inexplicada a pequeños esfuerzos tanto físicos como mentales que resulta claramente invalidante para el paciente. Suele acompañarse de un contexto sintomático de tipo inflamatorio. Su etiología y patogenia son desconocidas, aunque se postula una hipótesis posviral con disfunción inmunológica asociada. No existe ningún marcador diagnóstico específico. El diagnóstico es clínico mediante la utilización de unos criterios consensuados que exigen la realización de un amplio diagnóstico diferencial de las causas orgánicas y psicológicas de fatiga. Tiene un curso crónico, persistente y con oscilaciones, que ocasionan al paciente una considerable invalidez funcional no se dispone de ningún tratamiento curativo, aunque la terapia cognitiva conductual, el ejercicio físico progresivo y el tratamiento farmacológico de soporte ayudan a la mejoría sintomática (AU)

Increased circulating leptin levels in chronic alcoholism.

BACKGROUND: Malnutrition seen in chronic alcoholics is partly due to reduced energy intake. Leptin is a peptide hormone implicated in the regulation of appetite and expenditure of energy. The prevalence and significance of abnormal circulating leptin levels in alcoholics, as well as the relationship of these levels with nutritional status, liver disease, and ethanol consumption, remain uncertain. METHODS: Serum leptin levels were measured in 60 active asymptomatic alcoholics, 20 active alcoholics with cirrhosis of the liver, 20 abstinent alcoholics, and 60 controls. Nutritional status and ethanol consumption also were assessed. RESULTS: In the control group, circulating leptin levels (mean 4.7+/-0.3 microg/liter) correlated with body fat stores. Despite showing a lower fat area of the arm, active alcoholics had significantly higher leptin levels than the controls (p < 0.001), regardless of the presence of cirrhosis. By contrast, none of the abstinent alcoholics showed hyperleptinemia. In the multivariate regression analysis, the fat area of the arm (p < 0.001), the lifetime ethanol consumption (p = 0.007), and the number of cigarettes smoked per day (p = 0.02) were found to be independent factors that influenced leptin levels in active alcoholics. After we adjusted for age, fat area of the arm, and tobacco consumption, a significant correlation was observed between lifetime consumption of ethanol and serum leptin concentrations (r = 0.36, p < 0.001). CONCLUSIONS: Circulating leptin levels are increased in a dose-dependent manner in chronic alcoholism, regardless of nutritional status or the presence of compensated liver disease.

Effects of alcohol on the heart.

Some evidence suggests that light to moderate alcohol consumption protects against cardiovascular diseases. However, this cardioprotective effect of alcohol consumption in adults is absent at the population level. Approximately 20 to 30% of patients admitted to a hospital are alcohol abusers. In medical practice, it is essential that patients' levels of consumption are known because of the many adverse effects that might result in the course of routine care. Ethanol damage to the heart is evident if alcohol consumption exceeds 90 to 100 g/d. Heavy ethanol consumption leads to increased risk for sudden cardiac death and cardiac arrhythmias. In patients with coronary heart disease, alcohol use was associated with increased mortality. An early response to drinking was an increased ventricular wall thickness to diameter ratio, possibly proceeding with continuous drinking to alcoholic cardiomyopathy, which had a worse outcome compared with idiopathic dilative cardiomyopathy if drinking was not stopped or at least reduced (< 60 g/d). In the ICU, patients with chronic alcoholism have more cardiac complications postoperatively. These complications probably are caused by biventricular dysfunction, particularly with the occurrence of severe infections or septic shock, events that are three to four times more frequent among chronic alcoholics than occasional drinkers or nondrinkers. To prevent further complications from drinking and for long-term management of drinking, patients with alcohol abuse and heart failure should be treated in brief intervention and follow-up programs. Prognosis is good even in patients with New York Heart Association class IV heart failure caused by cardiomyopathy if complete abstinence is accomplished. Noncompliance to smoking and alcohol restrictions, which are amenable to change, dramatically increases the risk for hospital readmissions among patients with heart failure.

Distrofia simpática refleja y cirrosis biliar primaria / Reflex sympathetic dystrophy and primary biliary cirrhosis

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