The other targets of alcohol use disorder : The systemic effects of alcohol abuse

Drinking alcohol is an established and normalised practice in our society, even though it can physically harm us. High-risk alcohol drinking patterns can increase the chance of negative consequences for the drinkers or their environment. The liver is by far the organ most affected by alcohol abuse; however, alcohol use disorder is a systemic disease which affects a wide range of organs and psychological processes. Other systems that can be affected by continued alcohol consumption include the immune, neurological, and cardiovascular systems. In addition, alcohol can lead to epigenetic alterations that may be transmitted from one generation to the nex

"I'll be a kindergarten teacher and I don't sing well, but it doesn't matter". Analysis of self-concept and use of the singing voice in early childhood education degree students

Cantar en el aula es importante para el desarrollo de niños y niñas y para que esto suceda el profesorado debe ser competente en dicha actividad. En este estudio transversal, se analiza el uso de la voz cantada, el autoconcepto vocal y emocional con relación al contexto y la salud vocal del futuro profesorado de Educación Infantil (0-6 años) de tres universidades. Para ello, se ha pasado un cuestionario a 240 estudiantes (22-45 años; 200 mujeres; 40 hombres). Los resultados muestran que sólo en torno al 30% del alumnado cree que tiene una voz bonita, les es fácil cantar en el tono escrito y cantan afinado y sin esfuerzo. Aunque en aquellas personas que tienen un contexto familiar donde el cantar está presente no solo el autoconcepto mejora, sino que comprenden que para el profesorado es necesario cantar y hacerlo bien porque, entre otras cosas, serán un modelo vocal para sus estudiantes. El alumnado percibe tener buena salud vocal, no es lo que observan en sus tutoras-mentoras de prácticas, quienes a menudo usan música grabada y presentan alteraciones de la voz. Se concluye que los grados de maestro/a en Educación Infantil no consiguen dar suficientes recursos a sus estudiantes para mejorar su competencia y autoconcepto vocal.Singing in the classroom is important for children's development and for this to happen teachers must be competent in this activity. This transversal study analyses the use of the singing voice, vocal and emotional self-concept in relation to the context and vocal health of future early childhood education teachers (0-6 years) at three universities. For this purpose, a questionnaire was administered to 240 students (22-45 years; 200 females; 40 males). The results show that only about 30% of the students believe they have a beautiful voice, find it easy to sing in the written pitch and sing in tune and effortlessly. However, those who have a family context where singing is present, not only does their self-concept improve, but also understand that for a teacher it is necessary to sing and sing well, because, among other things, they will be a vocal role model for their students. Although the students perceive themselves to be in good vocal health, this is not what they observe in their internship tutors-mentors, who often use recorded music and present voice alterations. It is concluded that the Early Childhood Education degrees fail to provide enough resources to their students to improve their vocal competence and self-concept

Markers Of Inflammation And Mortality In A Cohort Of Patients With Alcohol Dependence

Inflammation and intestinal permeability are believed to be paramount features in the development of alcohol-related liver damage. We aimed to assess the impact of 3 surrogate markers of inflammation (anemia, fibrinogen, and ferritin levels) on mid-term mortality of patients with alcohol dependence. This longitudinal study included patients with alcohol dependence admitted for hospital detoxification between 2000 and 2010. Mortality was ascertained from clinical charts and the mortality register. Associations between markers of inflammation and all-cause mortality were analyzed with mortality rates and Cox proportional hazards regression models. We also performed a subgroup analysis of mortality rates in patients with anemia, based on their mean corpuscular volume (MCV). We included 909 consecutive patients with alcohol dependence. Patients were mostly male (80.3%), had a median age of 44 years (interquartile range [IQR]: 38-50), and upon admission, their median alcohol consumption was 192 g/day (IQR: 120-265). At admission, 182 (20.5%) patients had anemia; 210 (25.9%) had fibrinogen levels > 4.5 mg/dL; and 365 (49.5%) had ferritin levels > 200 ng/mL. At the end of follow-up (median 3.8 years [IQR: 1.8-6.5], and a total of 3861.07 person-years), 118 patients had died (12.9% of the study population). Cox regression models showed that the presence of anemia at baseline was associated with mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11-2.52, P< 0.01); no associations were found between mortality and high fibrinogen or high ferritin levels. A subgroup of patients with anemia was analyzed and compared to a control group of patients without anemia and a normal MCV. The mortality ratios of patients with normocytic and macrocytic anemia were 3.25 (95% CI: 1.41-7.26; P< 0.01) and 3.39 (95% CI: 1.86-6.43; P< 0.01), respectively. Patients with alcohol dependence admitted for detoxification had an increased risk of death when anemia was present at admission. More accurate markers of systemic inflammation are needed to serve as prognostic factors for poor outcomes in this subset of patients

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

Liver Ultrasound Abnormalities in Alcohol Use Disorder

Alcohol-related liver disease is the most common alcohol-related medical illness, and it is the major driver of liver-related deaths worldwide. However, no screening guidelines currently exist for the early detection of liver disease in patients with risky drinking or those with alcohol use disorder. Moreover, most patients with alcohol-related liver fibrosis, which is the main prognostic factor of progression to end-stage liver disease, have normal blood tests. Abdominal ultrasound is a cheap and readily available diagnostic procedure that is rarely used in patients with alcohol use disorder without overt liver disease. In addition, abdominal ultrasound can detect other forms of liver disease, which are not uncommon in patients with unhealthy alcohol use, and can have a negative impact on the natural history of alcohol-related liver disease. In this chapter we will review the current knowledge about the use of liver ultrasound in patients with alcohol use disorder for the early detection of alcohol-related liver disease, as well as the potential use to detect other forms of liver disease. We will also briefly discuss other methods for the noninvasive detection of liver steatosis and/or liver fibrosis in patients with alcohol use disorder

Differences in the Impact of COVID-19 on Pathology Laboratories and Cancer Diagnosis in Girona

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Càncer; Diagnòstic; PatologiaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Cancer; Diagnóstico; PatologiaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Cancer; Diagnosis; PathologyIntroduction: The recent COVID-19 pandemic has compromised socio-health care, with consequences for the diagnosis and follow-up of other pathologies. The aim of this study was to evaluate the impact of COVID-19 on cancer diagnosis in Girona, Spain. Methodology: Observational study of samples received in two pathology laboratories during 2019-2020 (tertiary hospital in Girona and county hospital in Figueres). Date, sample type, and location and morphology were available. Samples were recoded to determine malignancy and grouped by location. Comparisons were made by calendar year and period of exposure to COVID-19. Results: 102,360 samples were included: 80,517 from Girona and 21,843 from Figueres. The reduction in activity in the pathology laboratories in 2020 compared to the previous year was 25.4% in Girona and 27.5% in Figueres. The reduction in cancer diagnoses in 2020 compared to 2019 was 6.8% in Girona and 21% in Figueres. In both laboratories, a decrease was observed in the diagnoses of neoplasms of the lip, oral cavity and pharynx, larynx, colon, rectum and anus, kidney and urinary system, melanoma, and central nervous system. A statistically significant higher probability of a sample received in the pathology laboratory displaying malignancy during COVID-19 was found (Girona: OR = 1.28, 95% CI: 1.23-1.34; Figueres: OR = 1.10, 95% CI: 1.01-1.20) with respect to the COVID-19-free period. Conclusions: The COVID-19 pandemic has resulted in a reduction in cancer diagnoses by pathology departments that varies according to tumor location and type of hospital. Despite this, the optimization of care resources and the recovery effort have partially reduced the impact of the pandemic in certain neoplasms.This work was partially funded by the Josep Carreras Leukaemia Research Institute (grant number: FIJC1100) and the Agency for Management of University and Research Grants, Government of Catalonia (grant number: 2017SGR00733

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

Markers of inflammation and mortality in a cohort of patients with alcohol dependence

Abstract.Inflammation and intestinal permeability are believed to be paramount features in the development of alcohol-related liver damage. We aimed to assess the impact of 3 surrogate markers of inflammation (anemia, fibrinogen, and ferritin levels) on mid-term mortality of patients with alcohol dependence. This longitudinal study included patients with alcohol dependence admitted for hospital detoxification between 2000 and 2010. Mortality was ascertained from clinical charts and the mortality register. Associations between markers of inflammation and all-cause mortality were analyzed with mortality rates and Cox proportional hazards regression models. We also performed a subgroup analysis of mortality rates in patients with anemia, based on their mean corpuscular volume (MCV). We included 909 consecutive patients with alcohol dependence. Patients were mostly male (80.3%), had a median age of 44 years (interquartile range [IQR]: 38-50), and upon admission, their median alcohol consumption was 192 g/day (IQR: 120-265). At admission, 182 (20.5%) patients had anemia; 210 (25.9%) had fibrinogen levels >4.5 mg/dL; and 365 (49.5%) had ferritin levels >200 ng/mL. At the end of follow-up (median 3.8 years [IQR: 1.8-6.5], and a total of 3861.07 person-years), 118 patients had died (12.9% of the study population). Cox regression models showed that the presence of anemia at baseline was associated with mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11-2.52, P < 0.01); no associations were found between mortality and high fibrinogen or high ferritin levels. A subgroup of patients with anemia was analyzed and compared to a control group of patients without anemia and a normal MCV. The mortality ratios of patients with normocytic and macrocytic anemia were 3.25 (95% CI: 1.41-7.26; P < 0.01) and 3.39 (95% CI: 1.86-6.43; P < 0.01), respectively. Patients with alcohol dependence admitted for detoxification had an increased risk of death when anemia was present at admission. More accurate markers of systemic inflammation are needed to serve as prognostic factors for poor outcomes in this subset of patient