Quantity of alcohol drinking positively correlates with serum levels of endotoxin and markers of monocyte activation.

It is unknown if LPS (lipopolysaccharides) and markers of immune activation, soluble CD14 (sCD14) and CD163 (sCD163) are associated with the quantity of alcohol consumption. 148 subjects were enrolled (97 excessive drinkers (ED) and 51 controls). Time Line Follow-Back questionnaire was used to quantify the amount of alcohol consumed. Serum LPS, sCD14, and sCD163 were measured. Peripheral blood mononuclear cells (PBMCs) were also isolated. Compared to controls, ED had higher total drinks in the past 30 days, higher levels of LPS, sCD14 and sCD163. The levels of serum LPS, sCD14, and sCD163 were higher among ED with recent alcohol consumption (last drink <10 days before enrollment) compared to those without recent drinking. Similar bacterial genome copy numbers were detected in control and ED groups. We found that ethanol primed PBMCs for LPS-induced inflammatory responses. A positive correlation between serum LPS, sCD14, sCD163 and the quantity of alcohol drinking was observed after adjusting for covariates and that abstinence was associated with decline in the levels of LPS, sCD14 and sCd163. We found an increase in the levels of LPS and markers of monocyte activations in ED. Further studies are needed to determine whether these can be used as the biomarkers for excessive alcohol use.

Predictors of medication refill-seeking behavior in the ED.

OBJECTIVE: Determine predictors of medication refill-seeking behavior in ED patients with chronic illness. METHODS/DESIGN: Prospective cross-sectional ED survey conducted for 6 weeks. SETTING: Public hospital ED (>140,000 visits per year). SUBJECTS: ED patients (>18 years) taking chronic medications for congestive heart failure, diabetes, and/or hypertension. RESULTS: Of 1168 patients surveyed, 344 (29%) presented to the ED secondary to running out of medications and requiring a medication refill. Univariate predictors included age younger than 50 years, non-Hispanic ethnicity, low income (<5000 dollars per year), self-pay payor status, and being told to call a primary care physician before medication would be refilled. Lack of knowledge about refill or pharmacy numbers on the medication bottle resulted in patients being more than twice as likely to be in the ED for a medication refill (odds ratio 2.4 [1.6, 3.6] and 2.0 [1.3, 2.9], respectively). CONCLUSION: Presenting for medication refills is common in ED patients with chronic illness.