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3.
Medicine (Baltimore) ; 98(51): e18270, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860973

RESUMO

RATIONAL: Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium. PATIENT CONCERNS: A 53-years-old man with a history of alcohol abuse was admitted in hospital for fever, paroxysmal atrial fibrillation cardioverted by Amiodarone and pulmonary infection. DIAGNOSIS: A case of recurrent severe endocarditis, with neurological complications both ischemic and hemorrhagic and heart failure caused by Streptococcus agalactiae in healthy man we reported. INTERVENTIONS: Surgery was performed 2 weeks after admission. OUTCOMES: The onset of intracranial hemorrhage delayed second cardiac surgery and the patient died because of end-stage heart failure. CONCLUSIONS: Infective endocarditis caused by S. agalactiae is very rare, particularly in patients without underlying structural heart disease. This study showed that IE due to S. Agalactiae is a disease with high mortality when associated with neurological complication, heart failure but especially when it is recurrent and hits valve prosthesis.


Assuntos
Alcoolismo/complicações , Endocardite Bacteriana/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus agalactiae , Alcoolismo/microbiologia , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia
4.
JAMA ; 322(24): 2422-2434, 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31860051

RESUMO

Importance: Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas with a prevalence of 42 to 73 per 100 000 adults in the United States. Observations: Both genetic and environmental factors are thought to contribute to the pathogenesis of CP. Environmental factors associated with CP include alcohol abuse (odds ratio [OR], 3.1; 95% CI, 1.87-5.14) for 5 or more drinks per day vs abstainers and light drinkers as well as smoking (OR, 4.59; 95% CI, 2.91-7.25) for more than 35 pack-years in a case-control study involving 971 participants. Between 28% to 80% of patients are classified as having "idiopathic CP." Up to 50% of these individuals have mutations of the trypsin inhibitor gene (SPINK1) or the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Approximately 1% of people diagnosed with CP may have hereditary pancreatitis, associated with cationic trypsinogen (PRSS1) gene mutations. Approximately 80% of people with CP present with recurrent or chronic upper abdominal pain. Long-term sequelae include diabetes in 38% to 40% and exocrine insufficiency in 30% to 48%. The diagnosis is based on pancreatic calcifications, ductal dilatation, and atrophy visualized by imaging with computed tomography, magnetic resonance imaging, or both. Endoscopic ultrasound can assist in making the diagnosis in patients with a high index of suspicion such as recurrent episodes of acute pancreatitis when imaging is normal or equivocal. The first line of therapy consists of advice to discontinue use of alcohol and smoking and taking analgesic agents (nonsteroidal anti-inflammatory drugs and weak opioids such as tramadol). A trial of pancreatic enzymes and antioxidants (a combination of multivitamins, selenium, and methionine) can control symptoms in up to 50% of patients. Patients with pancreatic ductal obstruction due to stones, stricture, or both may benefit from ductal drainage via endoscopic retrograde cholangiopancreatography (ERCP) or surgical drainage procedures, such as pancreaticojejunostomy with or without pancreatic head resection, which may provide better pain relief among people who do not respond to endoscopic therapy. Conclusions and Relevance: Chronic pancreatitis often results in chronic abdominal pain and is most commonly caused by excessive alcohol use, smoking, or genetic mutations. Treatment consists primarily of alcohol and smoking cessation, pain control, replacement of pancreatic insufficiency, or mechanical drainage of obstructed pancreatic ducts for some patients.


Assuntos
Pâncreas/cirurgia , Pancreatite Crônica , Dor Abdominal/terapia , Alcoolismo/complicações , Diagnóstico por Imagem , Predisposição Genética para Doença , Humanos , Manejo da Dor , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Prognóstico , Fatores de Risco , Fumar/efeitos adversos
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 417-424, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182861

RESUMO

Antecedentes y objetivo: La dieta mediterránea (DM) tradicional se asocia a un menor riesgo de padecer numerosos cánceres. Sin embargo, pocos estudios han analizado la relación de la DM con el riesgo de padecer cáncer de cabeza y cuello (CCyC). Se lleva a cabo un estudio de casos y controles en el que se compara la adherencia a la DM en pacientes diagnosticados de CCyC y población sana. Pacientes y método: Mediante el cuestionario Mediterranean Diet Adherence Screener (MEDAS), de 14 ítems, empleado en el estudio PREDIMED, se evalúa el nivel de adherencia a la DM tanto en casos obtenidos de pacientes diagnosticados de CCyC en el hospital 12de Octubre de Madrid, como en controles obtenidos de población sana de un centro de salud del Área, estratificando dicha adherencia en función de la puntuación: baja (≤7puntos), media (8-9puntos) y alta (≥10puntos). Se calcula el odds ratio (OR) para desarrollar CCyC en base a diferentes factores. Resultados: Se analiza una muestra de 168 individuos: 100 controles y 68 casos. El hábito tabáquico (OR: 2,98 [IC95%: 1,44-6,12]; p=0,003) y el consumo de alcohol (OR: 2,72 [IC95%: 1,39-5,33]; p=0,003) demuestran ser factores de riesgo para desarrollar CCyC. Sin embargo, la adherencia media-alta a la DM se asocia a menor riesgo de CCyC (OR: 0,48 [IC95%: 0,20-1,07]; p=0,052). Conclusiones: La adherencia media-alta a la DM se asocia a menor riesgo para desarrollar CCyC


Background and objective: The traditional Mediterranean diet (MD) is associated to a lower risk of suffering multiple tumors. However, few studies have analyzed the relationship between MD and the risk of developing head and neck cancer (HNC). A case-control study comparing adherence to MD was conducted in patients diagnosed with HNC and healthy population. Patients and methods: The level of adherence to MD was assessed using the 14-item MEDAS (Mediterranean Diet Adherence Screener) questionnaire, used in the PREDIMED study, in patients diagnosed with HNC at 12de Octubre Hospital in Madrid (cases) and in healthy subjects enrolled in a nearby primary health care center (controls). Adherence was stratified based on the score as low (≤7points), medium (8-9points), and high (≥10points). The odds ratio (OR) for developing HNC was estimated based on different factors. Results: A sample of 168 subjects (100 controls and 68 cases) was analyzed. Smoking (OR, 2.98 [95%CI: 1.44-6.12]; P=.003) and alcohol consumption (OR, 2.72 [95%CI: 1.39-5.33], P=.003) were strongly associated to HNC. However, medium-high adherence to MD was associated to a lower risk of developing HNC (OR, 0.48 [95%CI: 0.20-1.07], P=.052). Conclusions: Consistent medium-high adherence to MD contributes to decrease the risk of developing HNC


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dieta Mediterrânea , Neoplasias de Cabeça e Pescoço/dietoterapia , Fatores de Risco , Cooperação e Adesão ao Tratamento , Estudos de Casos e Controles , Inquéritos e Questionários , Fumar Tabaco/efeitos adversos , Alcoolismo/complicações , Análise Estatística , Intervalos de Confiança
7.
AIDS Behav ; 23(12): 3247-3256, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31401739

RESUMO

Alcohol, depression, and intimate partner violence (IPV) are endemic in sub-Saharan Africa. This article examines whether and how these conditions affect mothers living with HIV (MLH), compared to mothers without HIV (MWOH). In particular, we assess the influence of these comorbidities on engagement in HIV care and adherence to antiretroviral therapies (ARV) among MLH. Data on maternal HIV care are typically based on clinic samples, with substantial loss to follow-up. This study fills that gap by including all mothers in specified areas. A cohort study examines MLH in Cape Town, South Africa recruited in pregnancy and followed repeatedly for 5 years, compared to MWOH. Almost all (98%) pregnant women in 12 neighborhoods (N = 594) were recruited in pregnancy. Mothers and children were reassessed five times over 5 years with high retention rates at each of the six assessments, from 98.7% at 2 weeks to 82.8% at 5 years post-birth. MLH's uptake and adherence to HIV care was evaluated over time associated with maternal comorbidities of alcohol use, depressed mood, and IPV using mixed effects logistic regression. MLH have fewer resources (income, food, education) and are more likely to face challenges from alcohol, depression, and having seropositive partners over time than MWOH. Only 22.6% of MLH were consistently engaged in HIV care from 6 months to 5 years post-birth. At 5 years, 86.7% self-reported engaged in HIV care, 76.9% were receiving ARVs and 87% of those on ARV reported consistent ARV adherence. However, data on viral suppression are unavailable. Alcohol use, but not depressed mood or IPV, was significantly related to reduced uptake of HIV care and adherence to ARV over time. Adherence to lifelong ARV by MLH requires a combination of structural and behaviorally-focused interventions. Alcohol abuse is not typically addressed in low and middle-income countries, but is critical to support MLH.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/complicações , Alcoolismo/psicologia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação , Mães/psicologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/etnologia , Criança , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Gravidez , Qualidade de Vida , Parceiros Sexuais , África do Sul/epidemiologia , Adulto Jovem
8.
Transplant Proc ; 51(6): 1934-1938, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399178

RESUMO

Excessive alcohol consumption has a negative impact on graft survival after liver transplantation (LT). However, it is difficult to predict alcohol relapse before LT. This study surveyed the alcohol consumption of LT recipients to identify the risk factors for harmful drinking. We surveyed the alcohol consumption of LT recipients by using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). AUDIT-C scores ≥ 5 points in men and ≥ 4 points in women indicated a high risk for harmful and hazardous drinking. Excessive alcohol consumption was considered to be > 20 g per day. Ninety-nine LT recipients completely filled out the questionnaire. Alcohol consumption after LT was detected in 26 recipients (26.5%); 4 of them had alcoholic liver disease before transplantation and 22 did not have alcoholic liver disease. The amount of alcohol consumption per day significantly decreased after LT (alcohol consumption per day: 49.6 g before LT vs 8.1 g after LT, P < .05). Fourteen recipients (14.1%) consumed alcohol excessively after LT. The AUDIT-C score before LT and smoking were risk factors for excessive alcohol consumption in the multivariate analysis. To properly manage post-transplant recipients, assessing the risk of excessive alcohol consumption by using the AUDIT-C is necessary.


Assuntos
Alcoolismo/diagnóstico , Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado/efeitos adversos , Medição de Risco/métodos , Adulto , Alcoolismo/complicações , Feminino , Sobrevivência de Enxerto , Humanos , Hepatopatias Alcoólicas/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Operatório , Recidiva , Fatores de Risco , Inquéritos e Questionários
9.
Medicine (Baltimore) ; 98(34): e16891, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441866

RESUMO

RATIONALE: Alien Hand syndrome (AHS) is characterized in most patients by seemingly purposeful, involuntary movements of the extremities. It is not well known among physicians on account of its diverse clinical manifestations. PATIENT CONCERNS: We present a 57-year-old Chinese man who could not stop or turn himself around as he involuntarily and uncontrollably walked forward, which had happened frequently in the month prior to treatment. He had been a heavy drinker for thirty years before the onset of the disease, with an alcohol intake of 600 to 800 ml/day. DIAGNOSES: History of alcohol intake and the brain magnetic resonance imaging findings indicated a diagnosis of Marchiafava-Bignami disease. The patient was additionally diagnosed with Alien Hand Syndrome according to his clinical symptoms. INTERVENTIONS: The patient was treated with high doses of vitamin B for 1 month. OUTCOMES: The patient's abnormal behaviors never appeared during the treatment, and no instance of recurrence was observed during the 6 months of follow-up. LESSONS: The clinical manifestation of AHS is non-specific. Only by considering its diverse manifestation can doctors better understand the disease and achieve early intervention.


Assuntos
Síndrome da Mão Alienígena/etiologia , Doença de Marchiafava-Bignami/complicações , Doença de Marchiafava-Bignami/diagnóstico , Alcoolismo/complicações , Síndrome da Mão Alienígena/diagnóstico , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Doença de Marchiafava-Bignami/tratamento farmacológico , Pessoa de Meia-Idade , Tiamina/uso terapêutico , Complexo Vitamínico B/uso terapêutico
10.
Dtsch Med Wochenschr ; 144(16): 1135-1137, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416105

RESUMO

HISTORY AND CLINICAL FINDINGS: In this report, a 60-year old patient with a history of mixed nociceptive and neuropathic chronic pain after successful removal of oral squamous cell cancer is described who received outpatient pain treatment in our clinic. Moreover, the patient presented with a history of alcohol abuse as well as anorexia and weight loss. EXAMINATIONS AND DIAGNOSIS: The patient was in reduced general condition and cachectic nutritional status. In addition, he suffered from oral pain that radiated to both ears and a related loss of appetite. TREATMENT: In the light of progressive cachexia, we started regular medical cannabis (Sativex®, contains i. e. delta-9-tetrahydrocannabinol and cannabidiol). Despite good initial tolerability, medical cannabis was stopped early due to alcohol relapse of the patient. After termination of medical cannabis, the patient regained control of alcohol consumption and achieved sobriety. CONCLUSIONS: We suggest that medical cannabis only be prescribed with particular caution in patients with a history of alcohol abuse.


Assuntos
Alcoolismo/complicações , Abuso de Maconha , Maconha Medicinal , Dor do Câncer/tratamento farmacológico , Humanos , Masculino , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Pessoa de Meia-Idade , Neoplasias Bucais/psicologia , Neoplasias Bucais/terapia , Recidiva , Automedicação/psicologia
11.
Medicine (Baltimore) ; 98(31): e16701, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374062

RESUMO

The purpose of this study was to investigate the incidence and risk factors of head and neck cancer in living donor liver transplant (LDLT) recipients.This is a retrospective cohort study. A case-matched (1:4) comparison between recipients with and without developed head and neck cancer after LDLT was conducted. The differences between 2 groups were analyzed.The incidence of head and neck malignancy in our cohort was 9 of 453 (1.98%). Their cumulative survival rate was below 60% at 24 months after the diagnosis of head and neck cancer, and no recipients lived for more than 2 years after being diagnosed with stage IV cancer. In the case-control study, univariate analysis revealed that alcohol consumption (odds ratio [OR] = 8.75, 95% confidence interval [CI]: 1.55-49.56) and smoking (OR = 6.71, 95% CI: 1.20- 37.44) were factors associated with the incidence of head and neck cancer after LDLT.In the conclusion, recipients with head and neck cancer after LDLT may have a rather poor prognosis, especially those who are initially diagnosed with advanced-stage disease. Alcohol consumption and smoking may be the predisposing factors to head and neck cancer in LDLT recipients.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Transplante de Fígado/efeitos adversos , Transplantados/estatística & dados numéricos , Alcoolismo/complicações , Alcoolismo/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia
12.
Acta Neurol Scand ; 140(5): 342-349, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31343728

RESUMO

OBJECTIVE: To report the incidence rate of osmotic demyelination syndrome (ODS), associated risk factors, treatment, and long-term outcomes in a nationwide cohort. METHODS: We conducted a retrospective study of individuals diagnosed with central pontine myelinolysis (ICD-10 code G37.2) in the Swedish National Patient Register during 1997-2011. RESULTS: During the study period, we identified 83 individuals with ODS, 47 women and 36 men. Median age at diagnosis was 55 years. The incidence rate of ODS for the entire study period was 0.611 (95% CI: 0.490-0.754) per million person-years and increased during the study period from 0.271 (95% CI: 0.147-0.460) in 1997-2001 to 0.945 (95% CI: 0.677-1.234) individuals per million person-years in 2007-2011. Most cases (86.7%) were hyponatremic with a median sodium level at admission of 104 mmol/L. All hyponatremic cases were chronic. The cause of hyponatremia was multifactorial, including drugs (56.9%), polydipsia (31.9%), and vomiting or diarrhea (41.7%). A majority of patients (69.9%) were alcoholics. Hyponatremic patients were predominantly treated with isotonic saline (93.1%) and only 4.2% with hypotonic fluids. The median correction rate was 0.72 mmol/L/h. Only six patients were corrected in accordance with national guidelines (≤8 mmol/L/24/h). At three months, 7.2% had died and 60.2% were functionally independent (modified Rankin Scale 0-2). INTERPRETATION: We found an increasing incidence during the study period, which could partly be explained by increased access to magnetic resonance imaging. ODS occurs predominantly in patients with extreme chronic hyponatremia which is corrected too fast with isotonic saline. Most patients survived and became functionally independent.


Assuntos
Mielinólise Central da Ponte/epidemiologia , Adulto , Alcoolismo/complicações , Doença Crônica , Feminino , Humanos , Hiponatremia/complicações , Incidência , Masculino , Pessoa de Meia-Idade , Mielinólise Central da Ponte/etiologia , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Síndrome
13.
Pediatr Emerg Care ; 35(8): 585-588, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31335785

RESUMO

Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.


Assuntos
Inabilitação do Médico/psicologia , Médicos/psicologia , Autocuidado/métodos , Estresse Psicológico/psicologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adaptação Psicológica/fisiologia , Alcoolismo/complicações , Alcoolismo/psicologia , Analgésicos Opioides/efeitos adversos , Medicina de Emergência/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Inabilitação do Médico/estatística & dados numéricos , Presenteísmo/estatística & dados numéricos , Estresse Psicológico/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Reino Unido/epidemiologia
14.
Mycoses ; 62(10): 937-944, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31287920

RESUMO

BACKGROUND: Pulmonary cryptococcosis (PC) is not considered an rare, opportunistic infection anymore. The immunocompetent population accounts for an increasing proportion of the morbidity. OBJECTIVE: This study investigated the clinical characteristics of PC patients spanning 20 years, in a referral centre of China. PATIENTS/METHODS: We retrospectively investigated the clinical data of 99 patients with PC who were diagnosed at Peking Union Medical College Hospital (PUMCH) from January 1998 to December 2017. RESULTS: Pulmonary cryptococcosis incidence in PUMCH has seen sharp increase in two decades. There were 40.4% (40/99), 17.2% (17/99) and 42.4% (42/99) immunocompetent, mildly immunocompromised and severe immunocompromised patients, respectively. Significantly higher (P = .035) male predominance in immunocompetent and mildly immunocompromised groups (68.4%, 39/57) compared with severe immunocompromised group (45.2%, 19/42) was found. Overall, 27.5% (11/40) immunocompetent patients reported a significant difference (P = .02) in history of more than weekly drinking, higher than mildly or severe immunocompromised. No significant difference occurred in symptoms and radiographic characteristics among the groups. In pulmonary computerised tomography findings, the non-air pathway feature was the dominant distribution characteristics in all patients with PC (P = .002). The gap in body dissemination frequency between immunocompetent combined with mildly immunocompromised (5.26%, 3/57) and severe immunocompromised (19.0%, 8/42) was marginally significant (P = .05). CONCLUSIONS: Gender and alcohol drinking could be PC risk factors of concern in patients without severe immunodeficiency. No significant difference occurred in symptoms or radiographic characteristics between patients with different levels of immune status. The unique radiographic non-air pathway distribution in the lung may be the feature of Cryptococcus invasion that may enhance accurate diagnosis.


Assuntos
Criptococose/patologia , Pneumopatias Fúngicas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , China/epidemiologia , Criptococose/epidemiologia , Feminino , Humanos , Incidência , Pneumopatias Fúngicas/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-31288451

RESUMO

Traffic collisions have continuously been ranked amongst the top causes of deaths in Vietnam. In particular, drinking has been recognized as a major factor amplifying the likelihood of traffic collisions in various settings. This study aims to examine the relationship between alcohol use and traffic collisions in the current context of Vietnam. A cross-sectional study was conducted on 413 traffic collisions patients in six health facilities in the Thai Binh Province to investigate the level of alcohol consumption and identify factors influencing alcohol use among these patients. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scale was used to determine the problematic drinking behavior of the participants. The percentage of patients having problematic drinking was more than 30%. Being male, having a high household income, and working as farmer/worker were risk factors for alcohol abuse. People causing accidents and patients with a traumatic brain injury had a higher likelihood of drinking alcohol before the accidents. This study highlights the necessity of more stringent laws on reducing drink-driving in Vietnam. In addition, more interventions, especially those utilizing mass media like educational campaign of good behavior on social networks, are necessary to reduce alcohol consumption in targeted populations in order to decrease the prevalence and burden of road injuries.


Assuntos
Acidentes de Trânsito , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/complicações , Condução de Veículo/legislação & jurisprudência , Dirigir sob a Influência , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Fatores de Risco , Tailândia , Vietnã/epidemiologia
16.
Rev Med Suisse ; 15(654): 1177-1180, 2019 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-31166668

RESUMO

Patients suffering from alcohol use disorder (AUD) are at risk for malnutrition. The mechanisms are presented in this article. Nutrition disorders in the patient with AUD can include malnutrition, micronutrient deficiencies, overweight and obesity. They may contribute to tissue damage and to oncological and cognitive disorders encountered among patients with AUD. Refeeding syndrome can appear during the withdrawal period. A nutrition evaluation should be included in the evaluation of all patients with AUD.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Transtornos Nutricionais , Síndrome da Realimentação , Alcoolismo/complicações , Humanos , Transtornos Nutricionais/complicações , Obesidade
17.
Ann Transplant ; 24: 359-366, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31209197

RESUMO

BACKGROUND Alcohol use disorders affect 10% of the European population. Alcohol-related liver disease (ALD) is the most common indication for liver transplantation in Slovakia. The aim of this study was to determine the proportion of patients with ALD who received a liver transplant who had alcohol relapsed, and the risk factors for alcohol relapse, as well as to compare clinical outcomes according to relapse. MATERIAL AND METHODS A retrospective study of consecutive patients with ALD, who underwent liver transplantation in a single transplant center between May 2008 and December 2017. We included adult patients who received a liver transplant due to ALD and excluded those who died <1 month after liver transplantation. We recorded demographic and clinical characteristics, graft injury, and overall mortality and compared them between relapsers and abstainers. RESULTS During the study period, we reviewed 196 cases of liver transplantation in 191 patients. We excluded 87 patients for non-ALD etiology and 15 patients by predefined criteria. The final analysis was carried out in 89 patients, mean aged 55 years; 24.7% were female. We diagnosed relapse in 23 patients (26%) with harmful drinking in 52% and occasional drinking in 48% of relapsers. The independent risk factors associated with relapse were: smoking (OR=5.92, P=0.006), loss of social status (OR=7.61, P=0.002), and time after liver transplantation (OR=1.0008, P=0.015). Graft injury was more frequent in relapsers with 2 independent risk factors: occasional drinking (OR=12.7, P=0.0005), and harmful drinking (OR=36.6, P<0.0001); overall survival was unaffected. CONCLUSIONS We found relapse to alcohol drinking in 26% of patients who received a liver transplant for ALD. Risk factors associated with alcohol drinking relapse were time, cigarette smoking, and loss of social status. Graft injury was more frequent in relapsers, but mortality was similar between relapsers and non-relapsers.


Assuntos
Alcoolismo/cirurgia , Hepatopatias Alcoólicas/cirurgia , Alcoolismo/complicações , Feminino , Sobrevivência de Enxerto , Humanos , Hepatopatias Alcoólicas/etiologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Fatores de Risco
18.
Int J Mycobacteriol ; 8(2): 113-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210151

RESUMO

Background: Nonsuppression of viral load (VL) in HIV-infected patients on antiretroviral therapy (ART) is associated with increased HIV transmission and poor survival. The objective of this work was to evaluate the factors associated with the unsuppressed VL (VL >400 copies/ml) in HIV-1-infected patients after 6 months of the first-line ART. Methods: This was a retrospective cohort study of 181 patients living with HIV-1 on ART in Dermatology and Venereology Department of Mohamed V Military Teaching Hospital of Rabat, during the period between January 1, 2007, and January 1, 2017. Associated factors were identified through a logistic regression model. Results: Of the 181 patients, 76% were men. At inclusion, the median age was 35 years. Five variables (male sex, initial fasting glucose >1.1 g/l, alcoholism, smoking, and initial VL >10,000 copies/ml) were significantly associated (P < 0.05) with unsuppressed VL. In multivariate analysis, smoking (relative risk [RR]: 4.27, 95% confidence interval [CI]: 1.67-10.89) and initial VL >10,000 (RR: 9.78, 95% CI: 2.40-39.73) were associated independently with unsuppressed VL. Conclusion: Approximately 83% of the patients in the cohort had been able to suppress VL after 6 months of the first-line ART. Smoking and high initial VL were independent risk factors of unsuppressed VL. This work highlights the importance of developing and evaluating targeted interventions for patients at risk of unsuppressed VL on ART.


Assuntos
Antirretrovirais/efeitos adversos , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Resposta Viral Sustentada , Carga Viral , Adulto , Alcoolismo/complicações , Feminino , HIV-1/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos
19.
Rev Med Liege ; 74(5-6): 300-303, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-31206270

RESUMO

Psychiatric complications are commonly associated with alcoholism. Psychological symptoms appear during intoxication or in patients with concomitant psychiatric disorders or substance-induced psychiatric disorders. Moreover, the assessment of the psychiatric symptomatology is particularly challenging in patients who express difficulties to accept that the disorder is due to alcoholism. Psychotic reactions, affective disorders and anxiety disorders are the main psychiatric complications of alcoholism.


Assuntos
Alcoolismo , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Alcoolismo/complicações , Alcoolismo/psicologia , Humanos
20.
Rev Med Liege ; 74(5-6): 310-313, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31206272

RESUMO

Chronic alcohol consumption results in multiple peripheral and central nervous system dysfunctions. Some are due to the direct action of alcohol or its derivatives, others are induced by the vitamin deficiencies associated with alcoholism, others are eventually related to the failure of other vital organs, such as the liver. In this short review, we describe alcohol-induced neuropathy, Gayet-Wernicke syndrome, Korsakoff syndrome, alcoholic dementia, Marchiafava-Bignami syndrome, hepatic encephalopathy, alcoholic epilepsy and manifestations of alcohol withdrawal.


Assuntos
Alcoolismo , Demência , Encefalopatia Hepática , Encefalopatia de Wernicke , Alcoolismo/complicações , Alcoolismo/fisiopatologia , Demência/complicações , Encefalopatia Hepática/complicações , Humanos , Encefalopatia de Wernicke/complicações
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