Factors associated with discharge against medical advice from an inpatient alcohol and drug detoxification unit in Barcelona during 1993-2006

Records from 1,228 consecutively admitted patients (74.5% male) to an inpatient detoxification unit in Barcelona during 1993-2006 were examined to determine factors associated with discharge against medical advice (AMA). 21.5% of admissions were discharged AMA. In multiple logistic regression and compared to patients who were medically discharged; those discharged AMA were younger, more likely to be dependent on heroin, other opiates, cocaine or psychostimulants or be receiving suppression from methadone maintenance therapy [reference category: alcohol]. Assisting clinicians to identify patients most at risk for leaving inpatient detoxification AMA will enhance their ability to motivate such patients to remain in treatment

Antiretroviral Therapy (ART) Use, Human Immunodeficiency Virus (HIV)-1 RNA Suppression, and Medical Causes of Hospitalization Among HIV-Infected Intravenous Drug Users in the Late ART Era

Background: Antiretroviral therapy (ART) has reduced the rates and changed the causes of hospital admission. However, human immunodeficiency virus-positive intravenous drug users (HIV-IDU) continue to have increased hospitalizations and discharge diagnosis are less defined in the late ART era. Our aim was to examine ART use, HIV-1 RNA suppression, and hospital discharge diagnoses among HIV-IDU admitted to an urban hospital.Methods: A retrospective analysis was made of HIV-IDU admitted for medical causes for the first time (2006-2010). Surgical, obstetric, or mental (except HIV-associated neurocognitive disorder) diagnoses were excluded. Clinical characteristics, number of admissions, and primary discharge diagnoses were determined for each patient.Results: Three hundred and seventy-five admissions were recorded among 197 hospitalized HIV-IDU. Lifetime prevalence of ART use was 83.2% (164 of 197) and the rate of HIV-1 RNA <50 copies/mL was 38.1% (75 of 197). Primary discharge diagnosis groups were as follows:acterial infections (59.2%), chronic end-organ damage (16.8%), complications derived from injected drug use (16.8%), malignancies (9.1%), and opportunistic infections (6.6%). Chronic end-organ damage was diagnosed more frequently in patients with HIV-1 RNA <50 copies/mL (36% vs 4.9%; P < .000), and complications derived from injected drug use (23.8% vs 5.3%; P < .0008) and acquired immune deficiency syndrome (AIDS) opportunistic infections (19.8% vs 1.3% P < .019) were usually diagnosed in patients with HIV-1 RNA detectable viral load. Conclusions: Human immunodeficiency virus-positive intravenous drug users are admitted to hospitals mainly for non-AIDS-related illnesses; however, sustained HIV-1 RNA viral load suppression is poor and determines hospital discharge diagnoses. Providers need to be aware of the management of HIV-related comorbidities and reinforce strategies to improve ART retention in this population

La crisi dels opioides

En una editorial recentment publicada a Medicina Clínica els Drs. Daniel Fuster i Robert Muga, del Servei de Medicina Interna l'Hospital Universitari Germans Trias i Pujol discuteixen els orígens de l'emergència de salut pública als Estats Units relacionada amb l'augment de la prevalença del trastorn per ús d' opioides i l'augment alarmant de morts per sobredosi, que ha arribat a la xifra de 75000 a l'any. També es descriu la situació de l'ús d' opioides a Espanya i es discuteix si es possible que en el nostre medi hi hagi una emergència similar.En una editorial recientemente publicada en Medicina Clínica los Dres. Daniel Fuster y Robert Muga, del Servicio de Medicina Interna del Hospital Universitario Germans Trias i Pujol discuten los orígenes de la emergencia de salud pública en Estados Unidos relacionada con el aumento de la prevalencia del trastorno por uso de opioides y el aumento alarmante de muertes por sobredosis, que ha llegado a la cifra de 75000 al año. También se describe la situación del uso de opioides en España y se discute si es posible que en nuestro medio haya una emergencia similar

Un análisis a los pensamientos más oscuros de Francis Bacon (1902-1992) a través de su arte.

El siguiente trabajo de fin de grado presenta como tema principal el análisis y comentario de diversas obras del autor irlandés Francis Bacon, con el principal objetivo de entender sus pensamientos más oscuros, relacionándolos e identificándolos en dichas representaciones. En primer lugar, se realiza una aproximación a la vida del artista, para encontrar el origen de esos traumas que posteriormente en la adultez son reflejados en sus cuadros. Posteriormente se analizan cinco pinturas seleccionadas y representativas, para resaltar las características principales del autor y cómo plasma sus pensamientos y su drama interior y su forma de ver el mundo y cómo lo plasma en el lienzo.<br /

Hepatitis C infection substantially reduces survival of alcohol-dependent patients

Background: Heavy alcohol use is associated with life-threatening complications including progressive liver disease. We aimed to analyze the impact of hepatitis C virus (HCV) infection on survival and liver-related death in alcohol-dependent patients. Patients and methods: This is a longitudinal study in patients seeking treatment of alcohol abuse between 2000 and 2010. Information on alcohol use characteristics, alcoholic liver disease, and HCV infection were obtained at entry. Cumulated mortality and causes of death were ascertained through clinical records and death registry. Results: A total of 819 patients (81.6% men) underwent ethanol detoxification; age was 44 (interquartile range [IQR] 38-51) years; the duration of heavy alcohol use was 14 (IQR 6-24) years; and the alcohol consumption was 190 (IQR 120-250) g/day. The prevalence of HCV infection was 15.8%. There were 129 (16.9%) deaths during 5,117 persons-year (p-y) of follow-up (median follow-up 6.4 [IQR 4.3-9.2] years); 31 (24.6%) deaths were observed among the HCV-positive patients, and 98 (15.4%) deaths were observed among the HCV-negative patients. The mortality rate was significantly (P=0.03) higher among the HCV-positive patients (3.84x100 p-y; 95% confidence interval [CI]: 2.70, 5.46) than among the HCV-negative patients (2.27x100 p-y; 95% CI: 1.86, 2.77). Survival times for the HCV infected patients were 34% shorter (time ratio relative to HCV negative: 0.66; 95% CI: 0.51,0.86). The main causes of death in the HCV-positive and -negative patients were liver-related mortality (48.4%) and neoplasia (22.4%), respectively. The liver-related mortality was significantly higher among the HCV-positive patients (adjusted sub-distribution hazard ratio [asHR] 3.65; 95% CI: 1.72, 7.78; P=0.001). Conclusion: HCV infection compromises the survival of patients with alcohol abuse/dependence. The new direct antiviral agents for the treatment of HCV infection may result in better clinical outcomes

Assessment of liver disease in patients with chronic hepatitis C and unhealthy alcohol use

Hepatitis C virus (HCV) infection and unhealthy alcohol use are major drivers of the burden of liver disease worldwide and commonly co-occur. Assessment of underlying liver damage is a cornerstone of the clinical care of patients with chronic HCV infection and/or unhealthy alcohol use because many of them are diagnosed at advanced stages of disease. Early diagnosis of liver disease before decompensated liver cirrhosis becomes established is essential for treatment with direct acting antivirals and/or abstinence from alcohol consumption, which are the main therapeutic approaches for clinical management. In this review, we discuss current knowledge around the use of non-invasive methods to assess liver disease, such as abdominal ultrasound, controlled attenuation parameter, transient elastography, magnetic resonance imaging, and indices based on serum markers of liver injury

Increased Natural Killer Cells Are Associated with Alcohol Liver Fibrosis and with T Cell and Cytotoxic Subpopulations Change

Natural killer (NK) cells play a therapeutic role in liver fibrosis (LF). We aimed to analyze NK cells in heavy drinkers without cirrhosis or decompensated liver disease and establish correlations with other related subpopulations. Data on sociodemographic characteristics, alcohol consumption, laboratory parameters, and immunophenotyping of NK (CD16 + /CD56 +), T (CD3 +), B (CD19 +), NKT (CD16 + /CD56 + /CD3 +), and cytotoxic (CD3 - CD8 +) cells were collected. Fibrosis-4 (FIB-4) scores were used to compare patients without (FIB-4 3.25) advanced LF (ALF). We included 136 patients (76% male) with a mean age of 49 years who had a 15-year alcohol use disorder (AUD) and alcohol consumption of 164 g/day. Patients with ALF (n = 25) presented significantly lower absolute total lymphocyte, T cell, B cell, and NKT cell numbers than patients without LF (n = 50; p < 0.01). However, the NK cells count was similar (208 ± 109 cells/µL vs. 170 ± 105 cells/µL) in both groups. The T cells percentage was lower (80.3 ± 5.6% vs. 77 ± 7%; p = 0.03) and the NK cells percentage was higher (9.7 ± 5% vs. 13 ± 6%; p = 0.02) in patients with ALF than in those without LF. The percentages of NK cells and T cells were inversely correlated in patients without (r = -0.65, p < 0.01) and with ALF (r = −0.64; p < 0.01). Additionally, the NK cells and CD3 - CD8 + cell percentages were positively correlated in patients without (r = 0.87, p < 0.01) and with (r = 0.92; p < 0.01) ALF. Conclusions: Heavy drinkers without decompensated liver disease showed an increase in NK cells related to T cells lymphopenia and an increase in cytotoxic populations. The interaction of NK cells with other subpopulations may modify alcohol-related liver disease progression

Long-Term Mortality of Patients with an Alcohol-Related Wernicke-Korsakoff Syndrome

Aims: To characterize a series of contemporary patients with alcohol-related Wernicke's encephalopathy (WE) or Korsakoff's syndrome (KS) and to update the current prognosis of disease. Methods: Retrospective and prospective study of patients diagnosed with an alcohol-related WE or KS between 2002 and 2011 in a tertiary hospital. Socio-demographic, alcohol use characteristics, signs and symptoms, co-morbidity and blood parameters were obtained at admission. Patients were followed up until 2013 and causes of death were ascertained through the review of charts. Results: Sixty-one patients were included (51 with WE and 10 with KS). Among patients with WE, 78% were men and age at diagnosis was 57 years (interquartile range (IQR): 49-66). Twenty-three percent fulfilled the classic WE triad. Regarding Caine's criteria for WE, 70.6% presented with at least two out of four signs or symptoms. Median follow-up of patients with WE syndrome was 5.3 years (IQR: 2.6-8.8), the cumulated mortality was 45% and death rate of 7.4 × 100 person-years (95% confidence interval (CI): 4.8-10.9). Overall, 50% of patients would be expected to die within 8 years of WE episode and main causes of death included serious bacterial infections (44.5%) and cancer (33.3%). Conclusions: Survival of patients with an alcohol-related Wernicke-Korsakoff syndrome is poor; pursuing treatment of alcohol use disorder and early diagnosis of thiamine deficiency is a priority for improving clinical outcome

Quantum-wave evolution in a step potential barrier

By using an exact solution to the time-dependent Schr\"{o}dinger equation with a point source initial condition, we investigate both the time and spatial dependence of quantum waves in a step potential barrier. We find that for a source with energy below the barrier height, and for distances larger than the penetration length, the probability density exhibits a {\it forerunner} associated with a non-tunneling process, which propagates in space at exactly the semiclassical group velocity. We show that the time of arrival of the maximum of the {\it forerunner} at a given fixed position inside the potential is exactly the traversal time, $\tau$. We also show that the spatial evolution of this transient pulse exhibits an invariant behavior under a rescaling process. This analytic property is used to characterize the evolution of the {\it forerunner}, and to analyze the role played by the time of arrival, $3^{-1/2}\tau$, found recently by Muga and B\"{u}ttiker [Phys. Rev. A {\bf 62}, 023808 (2000)].Comment: To be published in Phys. Rev. A (2002

Association of hyperuricemia and gamma glutamyl transferase as a marker of metabolic risk in alcohol use disorder

Excessive alcohol consumption leads to overproduction of urates and renal function plays a critical role in serum uric acid levels. We aimed to assess associations of hyperuricemia in patients with alcohol use disorder (AUD) and comparable Glomerular Filtration Rate (GFR). A total of 686 patients undergoing treatment for AUD between 2013 and 2017 were eligible (77% men); age at admission was 47 years [interquartile range (IQR), 40-53 years], age of onset of alcohol consumption was 16 years [IQR, 16-18 years] and the amount of alcohol consumed was 160 g/day [IQR, 120-240 g/day]. Body Mass Index was 24.7 kg/m(2) [IQR, 21.9-28.4 kg/m(2)], eGFR was 105 mL/min/1.73 m(2) [IQR, 95.7-113.0 mL], 9.7% had metabolic syndrome and 23% had advanced liver fibrosis (FIB-4>3.25). Prevalence of hyperuricemia was 12.5%. The eGFR-adjusted multivariate analysis showed that relative to patients with GGT 300 U/L were 4.31 (95% CI 1.62-11.46) and 10.3 (95% CI 3.50-29.90) times more likely to have hyperuricemia, respectively. Our data shows that hyperuricemia in the context of AUD is strongly associated with serum GGT levels and suggest an increased cardio-metabolic risk in this population