Impact of the WHO “best buys” for alcohol policy on consumption and health in the Baltic countries and Poland 2000–2020

Funding Information: Funding: Research reported in this publication was in part supported by the (U.S.) National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), grant number 1R01AA028224 . This research was conducted as part of the project ‘Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states’ and we would like to thank the whole team for their input to wider discussions in generating the research reported in this paper. Content is the responsibility of the authors and does not reflect official positions of the NIAAA or the NIH. Publisher Copyright: © 2023Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.Peer reviewe

Rapid opioid detoxification with an implementation of the new method of gradually increasing dosage of naltrexone induction

Over the last decades opioid dependence and complications that go along with it have become a rapidly increasing social burden, as well as a vast problem for the whole healthcare system. Lithuania had 66% of psychoactive substances users, treated for the first time, who were heroin addicts (100% intravenous route), while the total rate in the European Union was only 25% (31,8% intravenous route). Obviously comparing with the values of other European Union countries, great demand for programs of qualified opioid addiction treatment remains. The Aim of the research is to identify which of the two naltrexone induction techniques during the rapid opioid detoxification procedure evokes a higher stress response and has higher influence on the acute, antagonist-induced opioid withdrawal and its expression of subjective and objective symptoms. According to the results of the research, Rapid opioid Detoxification under a conscious sedation technique, while using a gradual increase of naltrexone induction, induces neither subjective, nor objective increase in symptoms of opioid withdrawal. The practical use of this method does not require hospitalization in specialized centres, and this procedure could be especially effective for motivated patients

Greitoji opioidinė detoksikacija taikant naują palaipsniui didėjančių naltreksono dozių indukcijos metodą

Over the last decades opioid dependence and complications that go along with it have become a rapidly increasing social burden, as well as a vast problem for the whole healthcare system. Lithuania had 66% of psychoactive substances users, treated for the first time, who were heroin addicts (100% intravenous route), while the total rate in the European Union was only 25% (31,8% intravenous route). Obviously comparing with the values of other European Union countries, great demand for programs of qualified opioid addiction treatment remains. The Aim of the research is to identify which of the two naltrexone induction techniques during the rapid opioid detoxification procedure evokes a higher stress response and has higher influence on the acute, antagonist-induced opioid withdrawal and its expression of subjective and objective symptoms. According to the results of the research, Rapid opioid Detoxification under a conscious sedation technique, while using a gradual increase of naltrexone induction, induces neither subjective, nor objective increase in symptoms of opioid withdrawal. The practical use of this method does not require hospitalization in specialized centres, and this procedure could be especially effective for motivated patients

Alumi piktnaudžiaujančio vyro vartojamo hidrochlorotiazido sukeltos sunkios hiponatremijos diagnostika ir gydymas

Introduction: Beer potomania is a syndrome of severe hyponatremia caused by excessive beer consumption. The risk of hyponatremia increases in the case of a combination of beer potomania and the use of thiazide diuretics. Case report: A 55-year-old male patient with the anamnesis of a long-lasting alcohol use disorder was presented to the emergency department after seizures accompanied by an impaired mental status. He had been drinking beer regularly for ten years. On physical examination, the patient was tachypneic, tachycardic, disorientated, restless, the Glasgow Coma Scale score of 9, observed tremor, and the smell of alcohol from the mouth. Laboratory results showed plasma sodium 105 mmol/L, blood urea nitrogen 1.8 mmol/L, the alcohol concentration in the blood 0.06 g/l, and calculated serum osmolality 219 mOsm/kg H2O. After a detailed initial evaluation of the patient and labs for hyponatremia, a diagnosis of beer potomania was established. On the third day of hospitalization, the patient's anamnesis was filled with information about the use of Valsartan/hydrochlorothiazide, together with reduced salt intake in the diet for three months for arterial hypertension treatment. It was decided that the combination of heavy beer drinking with the use of diuretic and reduced consumption of salt provoked hyponatremia. The patient was treated with infusion therapy of sodium chloride; plasma sodium level reached 136 on the third day of treatment. Conclusions: This case represents an unusual syndrome of beer potomania in conjunction with hydrochlorothiazide usage and reduced salt consumption, which can result in severe hyponatremia that may provoke severe neurologic damage

Cocaine-induced myocardial injury

We report a case of 37-year-old male, who was admitted to the Vilnius University hospital Santaros Klinikos emergency department suffering from acute chest pain. ECG and elevated troponin level confirmed ST-elevation myocardial infarction, although coronary angiogram had not shown hemodynamically significant changes in coronary arteries. Patient admitted after using cocaine a day ago. To conclude, myocardial infarction is rare, but serious consequence of cocaine use. Clinicians should consider interrogating all young patients presented to the emergency department with acute chest pain for cocaine use

Cryptogenic stroke in young patients and cannabis use: case presentation and literature review

Approximately 10% of ischemic strokes occur in people under the age of 50 – this is called early on set or stroke in young adults. In this patient population, there is an especially high number of cryptogenic strokes, where etiology is not identified or several causes are identified, or their exact meaning is not entirely clear, e. g., patent foramen ovale. One of the possible explanations of the increasing incidence in early onset stroke includes an increasing use of psychoactive substances. Most commonly used psychoactive substance in the world and in Lithuania is cannabis; the consumption of synthetic cannabinoids (spice), which is often considered as harmless in society, is also growing. The first case of focal neurological deficiency associated with cannabis use was published five decades ago. There is a number of hypotheses explaining the effect of cannabis and synthetic cannabinoids use on the etiology of stroke, but their proof is difficult. In this article we present a case of cryptogenic stroke in a young patient and review literature on the relationship between the use of cannabis and synthetic cannabinoids and stroke

Profile of patients presenting with acute seizures: is alcohol-related seizures a big problem in Lithuania?

Purpose: The goal of the study is to determine the proportion of alcohol-related seizures (ARS) among acute onset seizure patients, and to assess the results within the context of previous studies. The secondary goal of the study is to compare the characteristics and lab test results between ARS and non-ARS subgroup. Method: We retrospectively evaluated demographical, laboratory and clinical data of 550 patients who have suffered an acute onset seizure and were admitted to the emergency department of Republican Vilnius University Hospital (RVUH) in Lithuania between February 2019 and October 2019. Results: A total of 273 (49,6%) cases of seizures were determined to be alcohol-related, 201 (73,6%) of which had an ICD-10-AM codes F10 or T51.0 attributed to them. Medical records of 72 (26.4%) patients were significant for history of alcohol abuse. The majority (84,2% vs 57,2%, p = 0,001) of the ARS patients were male, they have suffered more frequently from new-onset seizures (31,5% vs. 21,3%, p = 0,007) and more commonly presented with tongue biting (20,9% vs. 7,9%, p < 0,001) compared to non-ARS patients. Patients in ARS subgroup had a less pronounced neurological disease profile (brain tumours 0,4% vs 8,3; stroke 1,1% vs 14,38%; p = 0,001), but more often suffered from alcohol-related liver disease (ARLD), compared to non-ARS patients (11,4% vs. 1,4%; P < 0,001). Conclusion: ARS is a big problem in Lithuania, while approximately half of the patients had seizures related with alcohol abuse

Safety and effectiveness of opiate antagonist detoxification under general anesthesia

Objective. To evaluate safety and effectiveness of opiate antagonist detoxification under general anesthesia according to available prospective and retrospective data. Methods. We analyzed all detoxification cases that were performed in Vilnius University Emergency Hospital in the period of 2002–2005. Data of 65 patients from prospective, randomized, double-blind, placebo-controlled study and 21 retrospective cases were included in the study. Results. Full opiate receptor blockade was achieved in 85 cases (98.84%). No complications related to detoxification procedure or general anesthesia were recorded. Differences in procedure protocols and possible implications for clinical practice are discussed. Conclusions. The protocol of the prospective study may be recommended as a safe and effective detoxification method

Myocardial Rupture following Carbon Monoxide Poisoning

We present the first case of severe cardiotoxicity of carbon monoxide leading to myocardial rupture and fatal outcome. 83-year-old woman was hospitalized 4 hours after the fire in her house with no respiratory or cardiac symptoms. After two days, she has suffered sudden collapse leading to cardiac arrest. Postmortem examination revealed intramural haemorrhage with myocardial rupture at the apex of the left ventricle. Minimal stenosis was noted in the proximal coronary arteries with no evidence of distal occlusion or any other long-standing heart disease. This case supports recommendations for targeted cardiovascular investigations in cases of CO poisoning