Aims Valid measures to identify harmful alcohol use are important. Alcohol Use Disorders Identification Test (AUDIT) is a validated questionnaire used to self-report harmful drinking in several cultures and settings. Phosphatidylethanol 16:0/18:1 (PEth) is a direct alcohol biomarker measuring alcohol consumption levels. The aim of this study was to investigate how PEth levels correlate with AUDIT-QF and weekly grams of alcohol consumed among patients in two urban hospitals. In addition, we wanted to investigate the predictive value of PEth in identifying harmful alcohol use as defined by AUDIT-QF and weekly grams of alcohol cutoffs. Methods A cross-sectional study comprising acute medically ill patients with measurable PEth levels (≥0.030 μM) admitted to two urban hospitals in Oslo, Norway (N = 931) and Moscow, Russia (N = 953) was conducted using PEth concentrations in whole blood, sociodemographic data and AUDIT-QF questionnaires. Results PEth levels from patients with measurable PEth were found to be positively correlated with AUDIT-QF scores, with PEth cutpoints of 0.128 μM (Oslo) and 0.270 μM (Moscow) providing optimal discrimination for harmful alcohol use defined by AUDIT-QF (the difference between cities probably reflecting different national drinking patterns in QF). When converting AUDIT-QF into weekly grams of alcohol consumed, the predictive value of PEth improved, with optimal PEth cutpoints of 0.327 (Oslo) and 0.396 (Moscow) μM discriminating between harmful and non-harmful alcohol use as defined in grams (≥350 grams/week). Conclusions By using PEth levels and converting AUDIT-QF into weekly grams of alcohol it was possible to get an improved rapid and sensitive determination of harmful alcohol use among hospitalized patients.
ObjectivesThe use of psychoactive prescription medication is increasing in the general population. This is a cause for concern, particularly among the elderly, where physiological changes related to senescence increase the risk for adverse effects. While previous studies regarding psychoactive substance use have generally been population based, we sought to determine the frequency of such use among acutely hospitalised patients.SettingTwo emergency departments (EDs), one in Oslo and one in Moscow, admitting patients to Departments of Internal Medicine.Participants5583 patients aged ≥18 years participated, distributed evenly between genders and study locations. Patients unable to give informed consent were excluded. The study sites did not admit patients with surgical conditions and/or injuries.Primary and secondary outcomesThe presence of psychoactive substances was determined through blood analysis using liquid chromatography-mass spectrometry. Secondary outcomes comprised demographic data (including age, gender, employment and marital status), degree of psychological distress, concurrent alcohol use, and self-reported alcohol, psychoactive drug and illicit substance use.Results32.3% in Oslo and 12% in Moscow were positive for one or more psychoactive medicinal drugs (benzodiazepines, z-hypnotics, opioids or barbiturates). In Oslo, medicinal drug use was associated with being aged 61 to 70 years (OR 2.40, 95% CI 1.61 to 3.58) compared with 18 to 40 years, and psychological distress (OR 2.61, 95% CI 2.06 to 3.30). In Moscow, psychoactive medicinal drug use was also associated with psychological distress (OR 1.68, 95% CI 1.18 to 2.39), and was less common among patients aged 41 to 60 years (OR 0.62, 95% CI 0.43 to 0.88) than among patients aged 18 to 40 years.ConclusionA significant proportion of admitted patients used one or more psychoactive medicinal drugs, in particular benzodiazepines (Oslo and Moscow) and opiates (Oslo). We suggest formalised screening for inappropriate prescription drug use and increased adherence to clinical prescription guidelines.
Objective(s) : Since there is increasing evidence of serious deterioration in long-term Quality of Life (QoL) in COVID-19 intensive care unit (ICU) survivors, we identified predictors of poor quality of life in these patients. Design : Prospective cohort study. Setting : Research hospital repurposed in to a COVID-19 center. Participants : Consecutive patients admitted in COVID-19 ICU between March and June 2020. Interventions : A SF-36 questionnaire, which includes physical and mental items, was used 6 months after patients discharge. Measurements and Main Results : 403 patients were managed in the ICU with a hospital mortality of 181/403 (44.9%) while 16 (4.0%) further patients died within 6 months. Among the 125 questionnaire responders, only 32.0% and 52% had a normal quality of life in terms of the physical and mental component of health. Multivariable analysis identified low-molecular-weight heparin treatment in ICU as the only modifiable factor associated with an increase in physical component of QoL OR: 3.341 (95%CI 1.298-8.599), p=0.012, while age ≥52 years OR 0.223 and female sex OR 0.321 were significantly associated with a decrease in the physical component. Medical history of cerebrovascular insufficiency was significantly associated with a decrease in mental component of QoL OR: 0.125, while the only factor associated with an increase in the mental health component was BMI ≥ 27.6 kg / m2 OR 7.466. Conclusions : In COVID-19 intensive care unit survivors we identified treatment with low molecular weight heparin as a predictor of improved physical component of QoL at 6-months.
Over the two years of the novel coronavirus infection (COVID-19) pandemic, there has been an evolution of views in various fields of medicine, which has led to a powerful development of scientific research in the field of epidemiology, clinic, diagnosis and therapy of COVID-19. The article highlights the evolution of views and approaches to the study of the epidemiology and radiology of COVID-19. The data of molecular genetic studies are shown, which are the most important component of epidemiological surveillance. The study of the manifestations of the COVID-19 epidemic process made it possible to distinguish two stages in the development of the epidemiological situation in the Russian Federation. At the first stage of the epidemic, two rises in the incidence rate of the population were recorded, regulated by social and natural factors. The second stage of the epidemic was due to a change in the biological properties of the SARS-CoV-2 virus, followed by a change in the prevailing genovariants (Alpha, Delta and Omicron). At the second stage of the epidemic, three rises in the incidence of the population were recorded. The general principles for the use of radiodiagnosis methods, which are used primarily to detect lung damage in COVID-19, are given. With the accumulation of experience, a natural change in ideas about the algorithms for the use of visualization technologies has occurred.
We present a case of mechanical hemolysis as a complication of extracorporeal membrane oxygenation (ECMO) occurring in a COVID-19 patient as a result of pump head thrombosis. After emergency extracorporeal circuit replacement, hemoadsorption was initiated to address the negative hemolysis effects and plasma free hemoglobin rise in the setting of rapid clinical deterioration and impaired renal function. During therapy hemolysis severity reduced, the lactate dehydrogenase (LDH) levels decreased, while the P/F ratio increased two-fold. The patient was discharged from hospital on day 54 without the need for either oxygen therapy or dialysis. In the discussion section we addressed frequent issues of choosing therapy for ECMO complications.Conclusion. The timely, properly chosen, and clinically relevant use of hemoadsorption combined with advanced high-technology therapeutic procedures can have a positive impact on the patient's outcome.
Introduction. Glucocorticoids are used worldwide to control hyperinflammation in hospitalized COVID‑19 patients. Nevertheless, the debate on the appropriate initiation time, effective treatment duration and modes of administration is still ongoing.The aim of this retrospective group analysis was to evaluate the influence of early methylprednisolone (MP) administration mode on acute respiratory distress syndrome (ARDS) dynamics in patients with COVID‑19.Materials and methods. We performed a retrospective analysis of 61 patients, who received MP treatment in the infection unit of our institution. The patients were retrospectively grouped by the MP administration method: either pulse boluses (group 1), or initial loading bolus followed by continuous infusion (group 2). MP administration was initiated on day 3–4 after hospital admission, i. e., within the first 10 days of the manifestation of symptoms. This is an earlier corticoid administration start, than is being described in most publications.Results. The positive dynamics in the setting of MP therapy was more pronounced in the continuous infusion group. Intensive care unit (ICU) transfer was necessary for 10 patients (33.3 %) of group 2 and for almost twice as many (19 patients, 61.2 %) of group 1. Patients of group 1 required respiratory support escalation (to mechanical lung ventilation) more often. Overall survival at hospital discharge was 77.5 % in the bolus group (group 1) and 90.0 % in the continuous infusion group (group 2).Conclusion. Based on our experience and the results of statistical analysis, the early use of MP (within 10 days of the first symptoms manifestation) in the ‘bolus followed by continuous infusion’ mode in the setting of the infection unit may reduce disease severity, decrease the need for respiratory support escalation, lower the number of cases of non-invasive and invasive lung ventilation and increase survival of COVID‑19 patients. These results must be further studied in randomized controlled studies.
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