-Background -Alcoholism and alcoholic liver disease are both considered worldwide health problems. Objective -The prevalence of alcohol dependence, the associated risk factors and the concordance between the prevalence found and the data collected during the medical visit were evaluated. Methods -A prospective study evaluating gastroenterology outpatients at a public tertiary hospital was conducted. Two specific questionnaires to assess alcohol dependence were applied: Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE) and The Alcohol Use Disorder Identification Test (AUDIT). Data on comorbidities, clinical diagnosis and assessment of alcohol consumption by the attending physician were collected through medical records. Results -One hundred and seventy eight patients were interviewed, of which 119 (66.9%) were women and 59 (33.1%) were men, with mean age of 57 years. Thirty-three (18.5%) of the 178 patients were considered alcohol-dependent by the CAGE questionnaire. Thirteen (7.3%) patients scored 8 points or more on the AUDIT questionnaire. The agreement (kappa) between these questionnaires was 0.37 (P<0.001). The most consumed drink was beer. The median daily consumption of dependent patients was 64 g. None of the patients were undergoing treatment in a specific treatment center, and 14/33 (42.4%) patients considered themselves alcoholics. Only in 17/33 (51.5%) there was information about alcoholism in their respective medical records. In the bivariate analysis, male gender (P<0.001), onset of alcohol consumption before the age of 15 (P=0.003), daily alcohol consumption in the last 12 months (P<0.001) and smoking (P<0.001) were identified as risk factors. After multivariate analysis, only male gender (P=0.009) and smoking (P=0.001) were associated with alcoholism. Conclusion -The present study demonstrated a high prevalence of alcohol dependence in the gastroenterology outpatient clinic, being predominantly associated with male gender and smoking. It is worth noting that approximately half of the dependents were not identified as such in the medical appointment, evidencing the importance of the diagnostic approach in the alcoholic outpatient.
Alcohol abuse is the major source of liver disease. The prevalence of alcoholic hepatitis (AH) is unknown, but histologic studies demonstrated that AH may be present in approximately 10% to 35% of hospitalized patients with alcoholism. The assessment of severity permits the identification of patients that will improve without medical therapy and those that will have a high mortality if not treated. A variety of scoring systems has been used to quantity the severity of AH and guides its treatment. The scores more commonly used are: Maddrey's discriminant function (DF), Model for End-Stage Liver Disease (MELD), Glasgow Alcoholic Hepatitis Score (GAHS) and Age, serum Bilirubin, INR (International Normalized Ratio), and serum Creatinine (ABIC). Some others prognostic indexes assess the efficacy of treatment, like Lille score, and Early Change in Bilirubin Levels. Histologic findings are showed to predict additional findings like risk of infection and poor prognosis even in a subgroup considered of better prognosis. The authors strongly recommend liver biopsy to confirm the diagnosis of AH and to discriminate patients with risk of infection and death without medical therapy. In our point of view, this method has been showed to be the best prognostic markers for AH in nowadays. In conclusion, AH is a severe complication among heavy drinkers and frequently results in poor short term prognosis. Various clinical scores are useful to differentiate patients with high mortality if not treated and are similar in predicting the outcome. More recently, the liver biopsy and a histologic score including fibrosis, megamitochondria, neutrophil infiltration and bilirubinostasis showed promising results and should be recommended.
The introduction of the everolimus as immunosuppressant in the liver transplantation has been shown to be safe and effective in the prophylaxis and preservation of the renal function. Prospective follow-up and chart analysis of liver transplant patients treated with everolimus was performed. Purpose: To highlight the importance of the pharmacist in transplantation centers. Method: Along the study, 93 patients were included, being 72 under active treatment. The successful treatment depends on the multidisciplinary follow-up, and it is extremely important the involvement of the patient, making him to become positive and an active part of the treatment. Results: The most frequent problems were: patients cutting the everolimus tablet, late SL after dose adjustment, lack of adhesion to the collection, and serum level collection out of time. Discussion: Upon the introduction of new drugs, it is required to observe possible adverse events further to ensure that the patient correctly follows the treatment. Conclusion: The presence of the pharmacist in the transplantation center allows the patient to get a reference to clarify doubts on the proper use of immunosuppressant.
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