Alcohol Abuse Research Articles

Pathological narcissism mentalization and gender differences in alcohol misuse among emerging adults

BackgroundEmerging adulthood is a developmental phase marked by increased vulnerability to risky behaviors, including alcohol misuse. Pathological narcissism, particularly grandiose and vulnerable traits, has been identified as a key factor influencing alcohol misuse. The role of mentalized affectivity (namely, the ability to identify, express, and process emotions) may enhance these associations, along with potential gender differences in these dynamics.MethodsA cross-sectional study was conducted with 1,075 emerging adults (M = 24.26, SD = 2.43; 71.2% assigned female at birth), using self-reports to measure pathological narcissism, mentalization difficulties, and alcohol misuse. Hierarchical regression models were used to examine the relationships between narcissistic traits, mentalized affectivity, and alcohol misuse.ResultsGrandiose narcissism was associated with alcohol misuse in the total sample. Narcissistic vulnerability was a stronger predictor of alcohol misuse in female individuals, while difficulties in mentalization (identifying and expressing emotions) were significant predictors of alcohol misuse in males. Grandiose narcissism did not directly predict alcohol misuse in either gender, after controlling for Narcissistic vulnerability.ConclusionsVulnerable narcissism plays a significant role in alcohol misuse, especially in female individuals, with mentalization difficulties exacerbating these behaviors, particularly in male individuals. Gender differences highlight the need for gender-specific interventions in emerging adults.

Aging and head and neck cancer insights from single cell and spatial transcriptomic analyses

BackgroundHead and neck squamous cell carcinoma(HNSCC) is the sixth most common malignancy worldwide, with more than 890,000 new cases and 450,000 deaths annually. Its major risk factors include smoking, alcohol abuse, aging, and poor oral hygiene. Due to the lack of early and effective detection and screening methods, many patients are diagnosed at advanced stages with a five-year survival rate of less than 50%. In this study, we deeply explored the expression of Aging-related genes(ARGs) in HNSCC and analyzed their prognostic significance using single-cell sequencing and spatial transcriptomics analysis. This research aims to provide new theoretical support and directions for personalized treatment.Annually, more than 890,000 new cases of head and neck squamous cell carcinoma (HNSCC) are diagnosed globally, leading to 450,000 deaths, making it the sixth most common malignancy worldwide. The primary risk factors for HNSCC include smoking, alcohol abuse, aging, and poor oral hygiene. Many patients are diagnosed at advanced stages due to the absence of early and effective detection and screening methods, resulting in a five-year survival rate of less than 50%. In this research, single cell sequencing and spatial transcriptome analysis were used to investigate the expression of Aging-related genes (ARGs) in HNSCC and to analyse their prognostic significance. This research aims to provide new theoretical support and directions for personalized treatment.MethodsIn this study, we investigated the association between HNSCC and AGRs by utilizing the GSE139324 series in the GEO database alongside the TCGA database, combined with single-cell sequencing and spatial transcriptomics analysis. The data were analyzed using Seurat and tSNE tools to reveal intercellular communication networks. For the spatial transcriptome data, SCTransform and RunPCA were applied to examine the metabolic activities of the cells. Gene expression differences were determined through spacerxr and RCTD tools, while the limma package was employed to identify differentially expressed genes and to predict recurrence rates using Cox regression analysis and column line plots. These findings underscore the potential importance of molecular classification, prognostic assessment, and personalized treatment of HNSCC.ResultsThis study utilized HNSCC single-cell sequencing data to highlight the significance of ARGs in the onset and prognosis of HNSCC. It revealed that the proportion of monocytes and macrophages increased, while the proportion of B cells decreased. Notably, high expression of the APOE gene in monocytes was closely associated with patient prognosis. Additionally, a Cox regression model was developed based on GSTP1 and age to provide personalized prediction tools for clinical use in predicting patient survival.ConclusionsWe utilized single-cell sequencing and spatial transcriptomics to explore the cellular characteristics of HNSCC and its interaction with the tumor microenvironment. Our findings reveal that HNSCC tissues show increased mononuclear cells and demonstrate enhanced activity in ARGs, thereby advancing our understanding of HNSCC development mechanisms.

Factors Influencing Medication Adherence in Heart Failure Patients-A Survey among Cardiac Healthcare Providers.

Adhering to medication regimens is key behavior to alleviate symptoms and slow disease progression in heart failure (HF). This study explores cardiac healthcare providers' perceptions and experiences of factors influencing medication adherence (MA) in HF patients, with findings contributing to developing a HF-specific MA assessment scale. Using a cross-sectional, mixed methods design, we conducted an online survey with both closed and open-ended questions distributed to cardiac healthcare providers, working at the National University Hospital in Iceland. The survey consisted of 103 questions divided into 18 themes. Analysis included descriptive statistics of the participants' responses to closed responses with simplified scoring. Free-text responses were grouped into thematic categories and then into subthemes. Of 104 healthcare providers invited, 73 (70%) participated. Key factors identified as most beneficial for supporting MA included supportive patient-provider relationships (97%), selecting suitable drug formulation (96%), healthcare support at home (95%), and multi-dose dispensing from pharmacies (93%). The youngest and oldest HF patients were believed to be at the highest risk of medication non-adherence, particularly among males. Other patients estimated at increased risk included those with alcohol and/or substance abuse (89%), those with limited knowledge of medication effects (89%), those perceiving medication as useless (88%), and those with cognitive impairment (86%). Most participants (73%) agreed that healthcare providers should assess and document MA in clinical care. These findings provide a comprehensive overview of factors that cardiac healthcare providers believe influence non-adherence in HF patients, contributing to the development of a HF-specific MA scale.

Challenges in early diagnosis of methanol poisoning in the emergency room - A case report

Background. Methanol is a toxic alcohol that causes severe poisoning due to its metabolites — formic and lactic acid — which lead to metabolic acidosis with a high anion gap and toxic encephalopathy. The severity of clinical features typically manifests within 6 to 72 hours and may include seizures and altered mental status. Case report. We present the case of a 45-year-old patient, a chronic alcoholic with no significant medical history, who was admitted to the Emergency Department in a comatose state (Glasgow Coma Scale [GCS] 4), tachypneic, and following a seizure episode. The patient also had a history of a minor head trauma 24 hours prior. Laboratory results revealed severe metabolic acidosis with a high anion gap, hepatocellular injury, renal insufficiency, and elevated serum levels of amylase and lipase. Toxicology screening, including a urinary sample, ethanol measurement (0 mmol/L), and imaging (MRI), strongly suggested methanol poisoning as the likely diagnosis. The patient was transferred to the Intensive Care Unit, where hemodialysis was performed. Subsequent brain scans revealed typical methanol toxicity patterns, including symmetrical necrosis of the basal ganglia and gliosis of the occipital and optic nerves. These findings underscore the importance of not attributing a low GCS solely to ethanol abuse, highlighting the need for a broader differential diagnosis.

How and when do work stressors and peer norms impact career entrants’ alcohol-related behavior and its consequences?

Do the key drivers of alcohol misuse change as young adults transition from early to late stages of employee onboarding? To answer this question, a series of hypotheses were tested based on two waves of data collected from 1240 college graduates from four different universities in the United States who reported obtaining full-time employment following college graduation. Data on alcohol misuse and hypothesized mechanisms—peer drinking norms and work-related stressors—were collected during the early (i.e. first few months on the job: T1) and late (12 months following initial assessment: T2) stages of employee onboarding. Results indicate that both a key work-related stressor (role overload) and injunctive peer drinking norms (i.e. those focusing on others’ approval) drive alcohol misuse in the transition from early to late stages of onboarding. However, while the relationships between injunctive peer drinking norms and alcohol misuse remain constant over the two measurement points, the mediated relationships between work-related stressors and alcohol misuse via distress is curvilinear and significantly weakens from early to late onboarding. We argue that this observed attenuation suggests that some risk factors can drive alcohol misuse in a way that is non-monotonic as well as dynamic over the course of emerging adults’ career entry.

HCV Treatment Outcomes in PWID: Impact of Addiction History on SVR12

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV.

Sexual Assault-Related Interactions and Social Reactions in the Initial Months Following Assault: A Daily Diary Study.

Most sexual assault survivors disclose to informal supporters and receive both negative and positive social reactions. Converging evidence suggests that the first months after sexual assault are a period of increased support-seeking that may be uniquely important to survivors' recovery, especially among survivors at risk of chronic post-traumatic stress and alcohol misuse. However, no research has examined when and how often survivors talk about their assault and what social reactions they receive during this time. As such, the goal of this study was to characterize the day-to-day assault-related interactions and social reactions received by a high-risk group of survivors during the first months following sexual assault. Adult female survivors of past-10-week sexual assault with elevated assault-related post-traumatic stress and alcohol use (N = 41) completed a baseline assessment and daily diaries over 21 days as part of a larger mHealth clinical trial. Results demonstrated that assault-related interactions occurred on an average of 24.4% of days (range: 1-14 days), were more likely to occur earlier in the daily dairy period, and decreased in frequency over time. Across days, most survivors (75%) received both positive and negative reactions in these interactions, whereas fewer (20%) received only positive reactions and no one received only negative reactions. These findings suggest that survivors commonly have assault-related interactions with their supporters in the initial aftermath of the assault and that receiving both positive and negative social reactions is typical. Findings could inform future early interventions aiming to improve supporter reactions and better support survivors' recovery.

Impact of working conditions and other determinants on the risk of substance misuse among healthcare residents: results of a cross-sectional study.

Substance misuse significantly impairs psychosocial functioning and correlates with many environmental factors, including working conditions. We investigated the influence of working conditions and other determinants on the risk of substance misuse among healthcare residents of city name withheld for review, France. We conducted an online survey among medicine, dentistry and pharmacy residents of city name withheld for review from May 30, 2022, to July 15, 2022. Participants reported their age, sex, residency specialty, and living conditions and completed the French Job Content Questionnaire, the Alcohol Use Disorder Identification Test - Consumption, and questions exploring their current tobacco, alcohol, and illicit drug use. We constructed directed acyclic graphs to model the effect of working conditions on substance misuse and used them to perform multivariable logistic regressions. Among the 1,936 residents of the city name withheld for review subdivision, 904 (46.7%) completed the survey. Among these, 54.0% exhibited alcohol misuse, 23.7% reported tobacco misuse, and 34.5% reported illicit drug misuse. Working more than 48 hours per week was not associated with any substance misuse. Low social support at work predicted the use of illicit drugs (aOR: 1.49, 95% CI [1.04; 2.13]). Compared with general medicine residents, psychiatric residents had greater odds of reporting tobacco misuse (aOR: 2.28, 95% CI [1.14; 4.58]) and illicit drug misuse (aOR: 2.51, 95% CI [1.33; 4.74]). Pediatric and pharmacy residents had lower odds of reporting alcohol misuse (aOR: 0.42, 95% CI [0.21; 0.84] and OR: 0.53, 95% CI [0.28; 0.98], respectively). Social support at work significantly impacts the risk of substance misuse among healthcare residents, as do other factors, such as residents' health specialty. These findings contribute to the development of appropriate institutional policies and support programs to improve the well-being of healthcare residents.

Prevalence of Alcohol Use Disorder among Medical Students in New Delhi: A Cross-Sectional Study

Abstract Introduction: Amid the global concern over alcohol consumption’s ramifications for public health, the escalating prevalence of alcohol misuse among young individuals, especially students, is alarming. This study examines the prevalence of alcohol use disorder (AUD) among medical students, exploring its link to depression, anxiety, and socioeconomic factors. Material and Methods: We conducted this cross-sectional study at a medical college in New Delhi in the month of June, 2023. We determined a sample size of 425 using prevalence estimates for AUD, a 4% margin of error, and a 15% nonresponse rate. We selected participants using simple random sampling from the MBBS enrollment list and provided them with self-administered questionnaires. We utilized validated screening tools, including PHQ-9, GAD-7, AUDIT-C, and CAGE, to assess depression, anxiety, and AUD. Statistical analysis was performed using STATA 18. AUD prevalence was presented with 95% confidence intervals. Associations between AUD and variables were examined using Chi-square tests. Significant variables (P < 0.2) in univariate analysis were considered in multivariate logistic regression (P < 0.05). Results: In our study, 413 students participated. The prevalence of AUD was 13.6%, depression was 31.5%, and anxiety was 24.2%. Univariate and multivariate logistic regression revealed significant associations between AUD and factors such as gender, current living space, tobacco use, and anxiety. Conclusion: The current study highlights worrisome levels of AUD, depression, and anxiety among medical students in New Delhi. Our research also reveals connections between AUD and factors like gender, living situation, tobacco use, and anxiety.

Aggressivity in Schizophrenia: The Risk and Confounders in a Romanian Setting

<p dir="ltr"><span>There is an increased stigma in Romania regarding schizophrenia patients, who are thought to be violent and dangerous. However, there is little research on this topic that analyzes the exact risk of aggressive behavior, especially considering the high prevalence of alcohol and substance abuse, conditions also associated with a potential risk of violent behavior. The objectives of this study were to compare aggressivity levels between patients with schizophrenia admitted to an emergency hospital and healthy individuals and to find possible risk factors. This case-control study, matched for age and gender included 50 patients hospitalized for schizophrenia and 50 healthy participants from an emergency psychiatric facility in Romania. We collected demographic data and screened for major mental disorders using the Mini International Neuropsychiatric Interview (MINI). Aggressivity levels were measured with the Buss-Perry Aggression Questionnaire (BPAQ). The CAGE questionnaire and the Drug Abuse Screening Test (DAST-10) were used to screen for alcohol and substance use disorder. The results highlighted a 3.93 times increase in aggressivity in the schizophrenia group, with the involvement of specific violent domains. Younger men with alcohol abuse had a higher risk of violent acts. Schizophrenia patients appear to present an increased risk of violence, but this must be carefully assessed and confounders considered. Public health programs are needed to increase treatment compliance and decrease alcohol and other psychoactive substances consumption. </span></p>

College students' sense of belonging and alcohol use amidst COVID-19: Evidence from a 21-day daily diary study.

Alcohol use, combined with the heightened mental health crisis among college students highlighted during the pandemic, remains a significant public health concern. We examine (1) how college students' daily assessed sense of belonging with their institution, a key protective factor for better collegiate mental health, is associated with same-day alcohol-use behaviors (2) and how the associations are moderated by key sociodemographic characteristics relevant to this population (women, minoritized students, first-generation [FG], and students identifying as Lesbian, Gay, Bisexual, Transgender, or Queer [LGBTQ]) amidst COVID-19. We used mixed models using data from a 21-day daily diary study of college students (N = 2,012) in Spring 2021. Results revealed that on days when students felt more uncertainty about their sense of belonging to their college (i.e., low belonging), they were less likely to drink, and drink less overall. This effect was observed after students were back on campus after pandemic-related college closures ended. Heterogeneity by minoritized student subgroups were also observed. College students' sense of belonging continues to be an important psychosocial determinant of health and health behaviors among young adults; at times in unintended ways. This reiterates the importance of examining dynamic relationships between belonging and population health. Public health significance statements: These results provide important insight into the linkages between a key psychosocial factor-students' sense of belonging in college-and their alcohol use patterns amidst COVID-19. Institutional programming and prevention efforts to curb alcohol misuse should be implemented with consideration of how those linkages may differ dynamically considering both between- and within-person variance in belonging.

Asian Americans' childhood emotional abuse, emotional neglect, and hazardous alcohol use: Resilience as moderator.

Asian Americans are highly underrepresented in alcohol use research, despite recent studies demonstrating the presence of hazardous alcohol use behaviors and increasing alcohol use rates among Asian Americans. Emotional abuse and emotional neglect serve as important individual factors that may impact hazardous alcohol use. The purpose of this study was thus to investigate (a) the association between childhood emotional trauma and hazardous alcohol use and (b) the role of resilience as a moderator. Asian American participants (N = 279) completed an online remote survey. Our findings revealed that childhood emotional neglect, but not emotional abuse, was significantly and positively associated with hazardous alcohol use. We found that resilience moderated the association between childhood emotional neglect and hazardous alcohol use so that only participants with average or high resilience experienced a significant association between childhood emotional neglect and hazardous alcohol use. The findings indicate that emotional neglect is a specific form of childhood trauma that is significantly associated with hazardous alcohol use, perhaps as a maladaptive coping mechanism. Additionally, marginalized populations that demonstrate resilience may suffer negative health outcomes such as hazardous alcohol use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gendered narratives and cultural shifts: A qualitative study on decadal changes in community alcohol consumption.

Alcohol consumption has been a central practice in Sabah, Malaysia. However, this region has witnessed a nuanced shift in drinking habits over the last decade, raising concerns about the health, economic, and social implications of alcohol use within the community in Sabah. This study explores the impact of gender narratives and cultural transformations on alcohol consumption within Sabah over the last decade. The objectives of this research include 1) assessing the shifts in alcohol consumption patterns over the last 10 years, 2) understand the role of gender differences in shaping these patterns, and 3) identify the economic consequences resulting from the changes. Employing a qualitative approach, we conducted focus group interviews with members of the native community, each group consisting of up to 7 participants. Thematic analysis was used to identify key themes pertaining to gender roles, cultural practices, and socioeconomic influences of alcohol consumption. The data were then contextualized using Bronfenbrenner's social-ecological model and social role theory. The study reveals a significant shift in drinking habits. Historically, alcohol was mostly consumed by men, but now more women are drinking, changing long-standing gender roles related to alcohol use. Children often copy their parents' drinking behaviors, and with alcohol being more easily available, more people are drinking than before. Our findings also expose the complex consequences of alcohol use, which extend to health concerns, familial tension, and economic hardship. Despite the entrenched cultural status of alcohol, these negative outcomes are exacerbated by a lack of supportive healthcare services. In light of these insights, the study suggests the need for intervention plans that respect the cultural background of Sabah and account for gender dynamics while tackling the current issues of alcohol misuse. The research adds to the wider conversation about managing alcohol in different cultural settings and also recommended strategies based on the findings, such as cultural and gender sensitive community programs, youth centered programs, community-based healthcare services, employment support and training and development of laws and policies.

DepXGBoot: Depression detection using a robust tuned extreme gradient boosting model generator

In terms of severity and prevalence, depression is the worst. Suicide rates have risen because of this and are on the rise universally. Consequently, effective diagnosis and therapy must reduce the impact of depression. There is often more than one factor at play when determining why someone has been diagnosed with depression. In addition to alcohol and substance abuse, other possible causes include problems with physical health, adverse reactions to medications, life-changing events, and social circumstances. In this paper, exploratory data analysis is conducted to understand the insights of the sensorimotor database depression comprising depressive experiences in individuals who are either unipolar or bipolar. This study proposes a robust tuned extreme gradient boosting model generator to automatically predict the state of depression. The performance is optimized by determining the best combination of hyperparameters for the extreme gradient boosting model. By harnessing the power of advanced machine learning methodologies, this study underscores comparative analysis and the importance of data-driven innovation in mental health and clinical practice. Future developments for the robust tuned extreme gradient boosting model’s application and study to forecast depression in the sensorimotor database depression can be used to track changes in depressed states over time by integrating it with longitudinal and multimodal data.

Corruption and Early Chief Constables in the County of Roxburgh: Sexual Misconduct, Thefts, Desertion and a ‘Disreputable Drunkard’

This article addresses a subject that has not been examined by scholars: the extent of corruption in early Scottish chief constables. Three men placed in charge of their forces in the county of Roxburgh between 1861 and 1902 succumbed to corruption. There are striking similarities in the backgrounds of the men: they were all married men, experienced police leaders, highly regarded by their previous forces and successful in their new roles. James McMaster abused his position of power to cajole a young constable into a homosexual relationship, Daniel Munro deserted the force with a married woman and John Macdonald experienced alcohol abuse issues. All three men stole from their force. The research presented here is grounded in primary sources ranging from police records, police commissioners’ minute books, the reports of the Inspector of Constabulary, the private correspondence of the duke of Buccleuch and local newspapers. The article describes the circumstances whereby their crimes were revealed and the reaction of their police commissioners. It also poses an important question: if this examination of one small rural county uncovers such a high level of criminality, how widespread was corruption amongst Scotland's early police leaders?

Jia Wei Qingxin Lotus Seed Drink ameliorates epithelial mesenchymal transition injury in diabetic kidney disease via inhibition of JMJD1C/SP1/ZEB1 signaling pathway

BackgroundDiabetic kidney disease (DKD) is one of the most common microvascular complications in patients with diabetes mellitus. In this condition, renal tubular epithelial mesenchymal transition (EMT) is an important factor accelerating the progression of DKD and a major cause of renal fibrosis and end-stage renal disease. However, the therapeutic effect is unsatisfactory because of the lack of effective drugs. Jia Wei Qingxin Lotus Seed Drink (QISD) is a traditional Chinese medicine compound formula that has shown to be effective in the clinical treatment of DKD. However, the potential of QISD in DKD-EMT treatment has yet to be fully explored. PurposeThis study aimed to investigate the role of QISD in ameliorating DKD-EMT injury and its mechanism. MethodsThe active ingredients of QISD were identified via ultra-performance liquid chromatography-mass spectrometry/mass spectrometry (UHPLC-MS/MS). A DKD mouse model was constructed by high-fat diet feeding and intraperitoneal injection of STZ (60 mg/kg), and QISD (14.46, 28.92, and 57.84 g/kg/day) was administered by gavage for 12 consecutive weeks. Dapagliflozin (1 mg/kg/d) was used as a positive control. Renal pathological damage was observed by HE, PAS, and Masson staining. The expression levels of EMT-related proteins and pathway proteins were detected via immunohistochemistry, RT-qPCR, and western blot. In in vitro experiments, EMT injury was induced in human kidney tubular epithelial cells (HK-2) by using lipopolysaccharide (LPS). A combination of CCK8 assay, wound healing assay, small-molecule inhibitor intervention, and overexpression lentiviral transfection was used to investigate the effects of QISD on cell migration ability, adhesion ability, fibrotic factor formation, and mesenchymal properties. ResultsAnimal experiments showed that QISD improved blood glucose, body weight, symptoms of excessive drinking and eating, and renal pathological injury in mice, reduced extracellular matrix deposition, delayed renal EMT injury, and inhibited the activation of the histone demethylase JMJD1C. UHPLC-MS/MS and molecular docking indicated that baicalin, wogonoside, oroxylin A-7-O-β-D-glucuronide, and glulisine A found in QISD could bind to JMJD1C. The ameliorating effect of QISD on DKD-EMT injury might be related to JMJD1C. The improvement of DKD-EMT injury by QISD was accompanied by the reduction of SP1 and ZEB1 expression. The SP1 overexpression not only reversed the therapeutic effect of JIB-04, an inhibitor of JMJD1C, on DKD-EMT but also exacerbated the expression of ZEB1 and downstream EMT-related factors. Thus, QISD might affect the expression of the epithelial marker E-cadherin by inhibiting the JMJD1C/SP1/ZEB1 signaling pathway, consequently preventing the transformation of epithelial cells to mesenchymal cells and ameliorating DKD-EMT injury. ConclusionThis study was the first to demonstrate that QISD might ameliorate DKD-EMT injury by inhibiting the JMJD1C/SP1/ZEB1 signaling pathway. These findings provide strong pharmacologic evidence for the clinical use of QISD in the treatment of DKD.

Recurrent Diabetic Ketoacidosis in Adolescents with Type 1 Diabetes Mellitus

Introduction: Diabetic ketoacidosis (DKA) is one of the serious complications that is often found in pediatric cases of type 1 diabetes mellitus (DM). Diabetic ketoacidosis mostly occurs in patients with low glycemic control. Currently, many studies are assessing risk factors for recurrent ketoacidosis, including young age, male gender, patients with comorbidities (psychiatric diseases, alcohol or substance abuse, other chronic diseases), and patients with socioeconomic factors. The incidence of recurrent diabetic ketoacidosis in children and adolescents is becoming more frequent. Risk factors that often trigger the incidence of diabetic ketoacidosis are important to understand to reduce the incidence of recurrent DKA. Case Presentation: This study reported a 17-year-old adolescent patient with a history of type 1 diabetes mellitus who had recurrent diabetic ketoacidosis. Patients come with complaints of nausea and vomiting, accompanied by a feeling of weakness. The results of the blood glucose test were 565 mg/dL. In urinalysis, a reduction of glucose was obtained (+3), and ketonuria with urinary ketones was obtained with a result of +3. A blood gas analysis showed a blood pH of 7,367 mmHg with HCO3 of 16.6 mmol/L and PCO2 of 28.6 mmHg. The initial management of the patient was given a loading of 0.9% NaCl fluid as much as 500 cc/hour for 2 hours, then 0.9% NaCl fluid as much as 500 cc mixed with KCL 10 meq at a rate of 75 ml/hour. The patient was also given an insulin drip to correct blood glucose levels in the form of 5 IU of insulin diluted with 0.9% NaCl, as much as 50 cc. During treatment, the patient's condition tends to stabilize, and the patient is discharged from the hospital by continuing with routine treatment with subcutaneous insulin. Conclusion: Diabetic ketoacidosis is one of the complications with high morbidity and mortality, especially in patients with type 1 diabetes mellitus. There are several risk factors associated with recurrent DKA in patients. Known risk factors for DKA allow health workers to prevent the occurrence of a recurrence of DKA.

Higher levels of plasmatic saturated fatty acid were significantly associated with liver fibrosis in HIV mono-infection: A case-control study

BackgroundThe relationship between plasmatic fatty acid (FA) composition and liver fibrosis remains scarce in people living with HIV/AIDS (PLWHA). We aimed to evaluate the association of plasmatic FAs and liver fibrosis in HIV mono-infected individuals. MethodsThis case-control study included PLWHA with liver fibrosis (cases) and randomly selected subjects without fibrosis (controls) from the PROSPEC-HIV study (NCT02542020). Participants with viral hepatitis, abusive alcohol consumption and lipid supplements use were excluded. Liver fibrosis was defined using transient elastography (TE) by liver stiffness measurement (LSM) ≥ 7.1 kPa or ≥ 6.2 kPa with M or XL probe, respectively. All HIV mono-infected participants with liver fibrosis identified at the baseline PROSPEC-HIV visit were included. Controls (1:1) were randomly selected among those HIV mono-infected participants without liver fibrosis. Plasmatic FA profile, dietary lipid intake, anthropometric measures, and blood samples were assessed. Plasmatic fatty acid was analyzed using gas chromatography and intake of fats lipids were assessed by two 24-h dietary recall (24-HDR). Multivariate logistic regression models adjusted by age, sex at birth and duration of antiretroviral therapy (ART) were performed. ResultsA total of 142 participants (71 cases and 71 controls) [62 % female, median age = 46 (IQR, 37–53) years, 14.8 % with diabetes, median CD4 count = 655 cells/mm3, 96.5 % under ART] were included. Higher percentages of plasmatic palmitc acid (16:0) and saturated fatty acids (SFA) were observed in participants with liver fibrosis (cases) compared to those without (controls). Presence of higher percentage of plasmatic palmitc acid (16:0) was associated with an increased odds for liver fibrosis [adjusted OR = 1.23 (95%CI 1.04–1.46); p = 0.02] in multivariate models. ConclusionThis study showed the potential role of the plasmatic FA composition in the pathogenesis of liver fibrosis in PLWHA.

DETERMINANTS IN MODELLING EARLY SCHOOL DROPOUT

Recognizing the importance of continuity in education, it was deemed necessary to carry out a study whose main objective is to identify the factors that lead to the intention to drop out in order to formulate effective strategies to combat this phenomenon. Early school dropout has negative consequences both for individual development and for social and economic progress. Therefore, this paper aims to contribute to the understanding and prevention of this phenomenon through a rigorous analysis of its determinants. In this context, eight relevant dependent variables have been identified in the literature that are believed to play a significant role in the intention to drop out of school. These variables include factors such as school absenteeism, alcohol or substance abuse, attitude, awareness, family, family supervision, school environment and school rules. The analysis used in the study examines these significant variables through structural equation modeling (SEM). SmartPLS software was used to conduct this analysis, which allows the use of Partial Least Squares SEM (PLS-SEM) and Bootstrapping modeling techniques. The data used for this research was collected using a well-structured questionnaire consisting of 28 questions aimed at capturing students' perceptions and experiences of school and the factors that might contribute to their intention to drop out of school. A total of 669 respondents completed the questionnaire, providing a solid database for analysis.

Phosphatidylethanol measures in patients with severe COVID-19-associated respiratory failure identify a subset with alcohol misuse.

Clinical trials in patients with COVID-19 have exclusively used self- or proxy-reporting to characterize alcohol consumption. The aim of this study was to measure an objective biomarker of recent alcohol use in patients hospitalized with severe COVID-19-associated respiratory failure who were enrolled in an investigational clinical trial to determine the prevalence of alcohol misuse, and to explore the relationship of alcohol use with outcomes. We conducted a substudy of patients enrolled in the multicenter, phase 2, adaptive platform design, Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging And molecular Analysis in COVID-19 trial (ClinicalTrials.gov: NCT04488081), conducted at 20 hospital systems across the United States. Three hundred and fifty-five patients with available red blood cell (RBC) samples and 60-day follow-up assessments were included. RBCs were utilized to measure phosphatidylethanol (PEth). Prespecified thresholds of PEth were utilized to stratify patients into groups: low/no alcohol use (PEth < 20 ng/mL), significant alcohol use (PEth 20-200 ng/mL), and heavy alcohol use (PEth ≥ 200 ng/mL). In this cohort, 17% of patients met criteria for significant alcohol use, while 4% met criteria for heavy alcohol use. Alcohol misuse was associated with diminished odds for home discharge, though this finding did not achieve statistical significance. In a cohort of patients with severe COVID-19 enrolled in a clinical trial, alcohol consumption of two or more standard drinks per day was present among 21%, approximating the proportion of patients with diabetes, and raising the possibility that alcohol consumption alters risk for severe viral pneumonia. Undetected alcohol misuse among clinical trial participants has the potential to influence study outcomes or contribute to adverse events.