Background Alcohol Research Articles

M112 - A STUDY ON THE ASSOCIATION OF POLYMORPHISMS AND METHYLATION STATUS OF DOPAMINE PATHWAY GENES IN ALCOHOL DEPENDENCE

Background Alcohol Dependence (AD), a chronic relapsing disorder, is a serious social and public health concern globally. Risk of AD is reportedly increased due to polymorphisms and methylation changes affecting transcription of the genes involved in various dopamine neurotransmitter gene pathways. The aim of this study was to identify polymorphisms and methylation changes in the SNCA and DAT genes of dopamine pathway in subjects with AD. Methods A total of 145 AD subjects from the outpatient department of Psychiatry and 110 healthy volunteers were recruited for the study. All subjects were interviewed with a semi-structured and WHO assist questionnaire. Blood samples drawn were subjected to DNA extraction, followed by sodium bisulphite modification and methylation specific PCR of the SNCA and DAT genes. DNA was also used to screen six polymorphisms of the dopamine pathway namely DRD4 120 bp duplication, DRD3 Ser9Gly, DRD2 Taq1α, COMT rs4680, COMT-287A>G and DRD4 -521C/T by PCR/RFLP. Genotype frequencies were calculated and their significance assessed using chi-square test and correlated with duration of alcohol use, age at onset of alcohol use, quantity of alcohol consumed (gms/day) and liver function. Statistical analysis was done through SPSS software V21.0. Results Of all the polymorphisms studied COMT Val158Met (rs4680) showed significant association with AD (p-0.03) compared to the others. SNCA gene methylation levels were significantly different between AD subjects and controls (p Discussion In the present study, significant difference between COMT rs4680 was observed between cases and controls. More heterozygosity was observed in cases which imply presence of low activity allele of COMT gene which affects the activity of enzyme and makes the individual more vulnerable to alcohol dependence. However, increased methylation at promoter region of DAT gene with both age and duration of alcohol use may lead to less re-uptake of dopamine from the synapse. Whereas, decreased methylation at promoter region of SNCA gene may help in the formation of synapse and hence increased dopamine neurotransmission. Therefore, this preliminary report suggests association of COMT rs4680 and methylation changes of SNCA and DAT genes with alcohol dependence.

M31 - GENOME-WIDE ASSOCIATION STUDY OF COMORBID ALCOHOL DEPENDENCE AND MAJOR DEPRESSION

Background Alcohol Dependence (AD) and Major Depression (MD) are leading causes of disability, and they often co-occur. Genetic epidemiologic data have shown that they share, at least to some extent, a common genetic etiology. The molecular nature of this shared genetic basis is poorly understood. To detect genetic risk variants for comorbid AD and MD and to determine whether polygenic risk alleles are shared with neuropsychiatric traits or subcortical brain volumes. Methods This Genome-Wide Association Study (GWAS) analyzed criterion counts of comorbid AD and MD in data sets of African Americans (AA) and European Americans (EA) that were collected as part of the Yale-Penn study of the genetics of drug and alcohol dependence from 2000–2013. After excluding subjects who were never exposed to alcohol or had missing information for any diagnostic criterion, we performed GWAS on two samples (“Yale-Penn-1” and “Yale-Penn-2”) totaling 4,653 AAs and 3,169 EAs. AAs and EAs were analyzed separately. We then tested whether Polygenic Risk Scores (PRS) derived from potentially related traits in EAs could be used to predict comorbid AD and MD. Comorbid criterion counts (ranging from 0–14) comprised for DSM-IV AD (7 criteria) and MD (9 criteria, scaled to 7). Results Of the 7,882 participants, 42.7% were female. The median comorbid criterion count was 6.2 (interquartile range [IQR], 2.3–10.9). Under the linear regression model, rs139438618 at the Semaphorin 3A (SEMA3A) locus was significantly associated with AD-MD comorbidity in AAs in the Yale-Penn-1 sample (beta coefficient [β]=0.89, P=2.76×10-8). In the Yale-Penn-2 sample, the association was also significant (β=0.83, P=2.06×10-4). Meta-analysis of the two samples yielded a more robust association (β=0.87 [95% CI, 0.61–1.12], P=2.41×10–11). There was no significant association identified in EAs. PRS analyses showed that individuals with a higher risk of neuroticism (β=1.01 [95% CI, 0.50–1.52]) or depressive symptoms (β=0.87 [95% CI, 0.32–1.42]) and a lower level of subjective well-being (β=-0.94 [95% CI, -1.46 to -0.42]) and educational attainment (β=-1.00 [95% CI, -1.57 to -0.44]) were at higher level of AD+MD; while larger intracranial (β=1.07 [95% CI, 0.50–1.64]) and smaller putamen volumes (β=-1.16 [95% CI, -1.86 to -0.46]) predicted higher risks of AD+MD. Discussion SEMA3A variation is significantly associated with comorbid AD and MD in AAs. Using PRS analyses, we identified pleiotropy with neuropsychiatric traits and brain volumes. Further studies are warranted to understand the biological and genetic mechanisms of this comorbidity, which could facilitate medications development and other treatments for comorbid AD and MD.

Alcohol and ideal cardiovascular health: The Multi-Ethnic Study of Atherosclerosis.

BackgroundAlcohol consumption is associated with cardiovascular disease (CVD), with moderate drinkers having decreased CVD risk compared to non‐ and heavy drinkers. However, whether alcohol consumption is associated with ideal cardiovascular health (CVH), assessed by the American Heart Association's (AHA) Life's Simple 7 (LS7) metrics, and whether associations differ by sex, is uncertain.HypothesisHeavy alcohol consumption is associated with worse CVH.MethodsWe explored associations between alcohol consumption and CVH in a multi‐ethnic population including 6506 participants free of CVD, aged 45 to 84 years. Each LS7 metric was scored 0 to 2 points. Total score was categorized as inadequate (0‐8), average (9‐10) and optimal (11‐14). Participants were classified as never, former or current drinkers. Current drinkers were categorized as <1 (light), 1 to 2 (moderate) and >2 (heavy) drinks/day. Multinomial logistic regression models assessed associations between alcohol and CVH, adjusted for age, sex, race/ethnicity, education, income, and health insurance.ResultsMean (SD) age was 62 (10) years, 53% were women. Compared to never drinkers, those with >2 drinks/day were less likely to have average [0.61 (0.43‐0.87)] and optimal CVH [0.29 (0.17‐0.49)]. Binge drinking was also associated with unfavorable CVH. Overall, there was no independent association for light or moderate drinking with CVH. However, women with 1 to 2 drinks/day were more likely to have optimal CVH [1.85 (1.19‐2.88)] compared to non‐drinking women, which was not seen in men.ConclusionHeavy alcohol consumption was associated with unfavorable CVH. Although light or moderate drinking may be associated with a more favorable CVH in women, overall, the association was not strong.

Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta-analysis.

Surgical myectomy (SM) and Alcohol septal ablation (ASA) are effective therapies for patients with hypertrophic cardiomyopathy who remain symptomatic despite medical therapy. A plethora of data has recently emerged on the long-term outcomes of these procedures. We hence sought to perform an updated meta-analysis comparing both procedures. Studies reporting long-term (>3-years) outcomes of SM and/or ASA were included. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, sudden cardiac death (SCD), reintervention, and complications including death, pacemaker implantation, and stroke. Twenty-two ASA cohorts (n = 4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up = 6.8-years) were included. Septal myectomy was associated with higher periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs 0.8% P = 0.013, respectively), but ASA was associated with more need of pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause mortality, cardiovascular mortality, and sudden cardiac death rates were 1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and 0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43), respectively. Repeat septal reduction intervention(s) were more common after ASA (11% vs 1.5%, P < 0.001). Compared with SM, ASA is associated with lower periprocedural mortality and stroke but higher rates of pacemaker implantations and reintervention. However, there was no difference between ASA and SM with regards to long-term all-cause mortality, cardiovascular mortality, or SCD.

Prevalence and Factors Influencing Alcohol Use in Pregnancy among Women Attending Antenatal Care in Dodoma Region, Tanzania: A Cross-Sectional Study.

Background Alcohol use during pregnancy is high despite the well-established evidence on its adverse pregnancy outcomes and poor child development. Early identification and behavioural modification are of great significance. This study aimed to determine the prevalence and associated factors of alcohol use during pregnancy among women in Dodoma region. Methods 365 randomly selected pregnant women attending antenatal care services in Dodoma region were included. Structured questionnaires were used to assess sociodemographic characteristic and alcohol use. Both descriptive and inferential analyses were used to estimate the prevalence and independent relationships of factors associated with alcohol use in pregnancy, respectively. Results Results showed a prevalence of 15.1% out of the 365 women attending antenatal services in Dodoma region. Prepregnancy alcohol use and having relatives who use alcohol were associated with alcohol use (AOR= 5.19; 95% CI: 4.791-34.867 and AOR=1.57; 95% CI: 1.393-6.248), respectively. Moreover, other associated factors included low education status (AOR=10.636; 95% CI: 1.89-19.844), making local brews as a source of income (AOR=11.44; 95% CI: 1.008-19.86), and not having had complications in previous pregnancies (AOR=4.93; 95% CI: 1.031-23.59). Conclusion There is a significantly high prevalence of alcohol use during pregnancy in Dodoma. Social networks and low social, economic status were associated with alcohol use in pregnancy. There is a need for public health interventions to address alcohol use particularly targeting women of reproductive age with low socioeconomic status.

Alcohol Outlets, Neighborhood Retail Environments, and Pedestrian Injury Risk.

Alcohol outlet density has been associated with increased pedestrian injury risk. It is unclear whether this is because alcohol outlets are located in dense retail areas with heavy pedestrian traffic or whether alcohol outlets contribute a unique neighborhood risk. We aimed to compare the pedestrian injury rate around alcohol outlets to the rate around other, similar retail outlets that do not sell alcohol. A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury emergency medical services (EMS) records from January 1, 2014 to April 15, 2015 (n=848); locations of alcohol outlets licensed for off-premise (n=726) and on-premise consumption (n=531); and corner (n=398) and convenience stores (n=192) that do not sell alcohol. Negative binomial regression was used to determine the relationship between retail outlet count and pedestrian injuries, controlling for key confounding variables. Spatial autocorrelation was also assessed and variable selection adjusted accordingly. Each additional off-premise alcohol outlet was associated with a 12.3% increase in the rate of neighborhood pedestrian injury when controlling for convenience and corner stores and other confounders (incidence rate ratio [IRR]=1.123, 95% confidence interval [CI]=1.065, 1.184, p<0.001). The attributable risk was 4.9% (95% CI=0.3, 8.9) or 41 additional injuries. On-premise alcohol outlets were not significant predictors of neighborhood pedestrian injury rate in multivariable models (IRR=0.972, 95% CI=0.940, 1.004, p=0.194). Off-premise alcohol outlets are associated with pedestrian injury rate, even when controlling for other types of retail outlets. Findings reinforce the importance of alcohol outlets in understanding neighborhood pedestrian injury risk and may provide evidence for informing policy on liquor store licensing, zoning, and enforcement.

Alcohol Consumption is Positively Associated with Handgrip Strength Among Japanese Community-dwelling Middle-aged and Elderly Persons

Summary Background Alcohol consumption is an important lifestyle factor for a variety of health problems, we investigated whether alcohol consumption is associated with handgrip strength (HGS), which is a useful indicator of sarcopenia, among Japanese community-dwelling persons. Methods The present study included 764 men aged 70 (69–70) years and 955 women aged 70 (69–70) years from a rural village. Daily alcohol consumption was measured using the Japanese liquor unit in which a unit corresponds to 22.9 g of ethanol, and the participants were classified into never drinkers, occasional drinkers, daily light drinkers (1–2 units/day), and daily moderate drinkers (2–3 units/day). Results HGS were significantly correlated with age in both men and women. HGS increased significantly with increased daily alcohol consumption in both genders, and in men HGS in daily moderate drinkers were significantly greater than those in never, occasional, and daily light drinkers. In women, HGS in daily light and moderate drinkers were significantly greater than those in never drinkers. In men, Multivariate-adjusted HGS were significantly greater in daily light {mean: 33.4 (95% confidence interval: 32.3–34.5) kg} and moderate drinkers {33.6 (32.8–34.0) kg} than in never drinkers {31.7 (30.8–32.7) kg}, and in women multivariate-adjusted HGS in occasional drinkers {21.5 (21.0–22.1) kg} was significantly greater in never drinkers {20.7 (20.5–21.0) kg}. Conclusion These results suggest that alcohol consumption may have a protective role in aging-associated decline in muscle strength in community-dwelling persons.

P.3.021 - Brain responses to beer reward: do alcohol consumption levels matter?

Background Alcohol use is prevalent during emerging adulthood [1]. Most studies investigating reward processing in alcohol users have used alcohol pictures [2] or monetary rewards [3], which are secondary reinforcers. In the current study, we developed a new paradigm based on the well-known Monetary-Incentive-Delay task, in which we crucially used beer sips as a primary reinforcer. Three different phases can be distinguished; the anticipation of a potential beer reward, the outcome signalling whether the beer reward was obtained, and the delivery of the sip of beer itself. The aims of the current study were to identify the brain activation patterns related to all three phases, and to investigate potential modulations by individual differences in alcohol consumption levels. For the latter purpose, three groups will be compared; light drinkers, at-risk drinkers and dependent drinkers. We hypothesized that reward-related brain areas, such as the striatum, insula and the ventromedial prefrontal cortex, would be more active in the beer than in the water condition across all three phases. Moreover, we hypothesized that the dependent group would show the most activation in the beer>water contrasts, followed by the at-risk group and the light drinkers. Methods The sample consisted of 150 beer drinking males between the age of 18 and 25. The groups were defined using AUDIT scores [4]; light 15, combined with a MINI-interview to confirm dependence in the last group. The participants were all beer-drinking students. All participants underwent a fMRI session in which they completed the modified MID task. The sip of beer or water (3ml) was delivered through a tube placed on the tongue. fMRI data was preprocessed and analyses using SPM8. Results Whole brain analyses revealed that participants showed increased activation in the medial prefrontal cortex (mPFC) and the orbito-frontal cortex (OFC) during the anticipation of a sip of beer compared to water. During the outcome phase, increased activation was found in the inferior frontal gyrus, the motor and visual cortex. During the actual delivery of a sip of beer compared to baseline, increased activation was revealed in the somatosensory cortex, the OFC, the mPFC, cerebellum, amygdala and caudate. Whole brain analyses investigating differences between the three groups revealed no significant results. Conclusions The results show that anticipating and receiving a sip of beer activates a number of brain regions partly overlapping with the reward circuitry. However, in contrast to our hypothesis, no differences were found between the groups of drinkers. These results suggest that reward processing of a primary reinforce may be not be as relevant as expected for explaining individual differences in drinking behaviour [5], as different types of drinkers seem to attribute the same rewarding value to beer across different phases of reward processing. We will extend the current findings by performing more statistical tests as well as region-of-interest analyses and using a continuous measure of alcohol consumption. Eventually, this will give us a better understanding of the rewarding value of alcohol consumption with the final aim to predict future hazardous drinking patterns.

Russian Federation university student alcohol use: Smolensk City—a case example

ABSTRACTAlcohol use that causes damage to health and adverse events is a significant public health concern. However, there is a dearth of information about alcohol use among Russian Federation university students. This cross sectional study of 626 students examined their background characteristics, alcohol use, heavy drinking and related problem behavior. Males were more inclined to use alcohol and drink heavily than females; however, no other gender related behavior differences were found. Regression analysis showed heavy drinking more prevalent among students who worked, lived on campus, missed class because of party habits, smoked cigarettes, mixed alcohol and energy drinks, and drank more because of stress. Study findings contribute to usable information for promoting university student health and well-being including academic success through policy and prevention practices as well as for examining the issue elsewhere for comparison and generalization purposes.

Effect of chronic exposure of Losartan in mouse prenatal alcohol exposure (PAE) model

Background and aimsFoetal alcohol syndrome (FAS) is a condition that currently affects 1% of babies born in Europe and North America. It is characterised by memory impairment, developmental delay and distinctive facial features. This research uses a mouse prenatal alcohol exposure (PAE) model to explore the effects of PAE on learning, memory and to explore the potentially beneficial effects of common drugs previously shown to have cognitive enhancing effects in both humans and animals.MethodsSixty mice (M = 30 F = 30) C57 mice were exposed to 5% ethanol throughout pregnancy. After weaning the offspring received Losartan (10 mg/kg) via their drinking water for 8 weeks. At 3 months, learning and memory was assessed using the novel object recognition paradigm.ResultsPAE caused a significant decrease in offspring body weight. Treatment with Losartan caused no growth impairment or renal damage. Novel object recognition indicated that PAE caused male offspring to spend significantly less time exploring the novel object than controls and that treatment with Losartan had the effect of improving awareness of the novel object both in the control and alcohol group and decreasing anxiety (P ≤ 0.05). A significant opposite effect was noticed in the female alcohol progeny when compared to the male alcohol progeny (P ≤ 0.05). Losartan in female alcohol progeny had no effect on anxiety. Male control Losartan spent more time exploring the novel object than male alcohol Losartan (P ≤ 0.05).ConclusionsLosartan had no deleterious effects on the development of the animals, and was able to improve learning and memory in control animals without effect in PAE mice.Disclosure of interestThe author has not supplied his declaration of competing interest.

Longitudinal influence of alcohol and marijuana use on academic performance in college students.

BackgroundAlcohol and marijuana are the two most abused substances in US colleges. However, research on the combined influence (cross sectional or longitudinal) of these substances on academic performance is currently scant.MethodsData were derived from the longitudinal 2-year Brain and Alcohol Research in College Students (BARCS) study including 1142 freshman students who completed monthly marijuana use and alcohol consumption surveys. Subjects were classified into data-driven groups based on their alcohol and marijuana consumption. A linear mixed-model (LMM) was employed using this grouping factor to predict grade point average (GPA), adjusted for a variety of socio-demographic and clinical factors.ResultsThree data-driven clusters emerged: 1) No/low users of both, 2) medium-high alcohol/no-low marijuana, and 3) medium-high users of both substances. Individual cluster derivations between consecutive semesters remained stable. No significant interaction between clusters and semester (time) was noted. Post-hoc analysis suggest that at the outset, compared to sober peers, students using moderate to high levels of alcohol and low marijuana demonstrate lower GPAs, but this difference becomes non-significant over time. In contrast, students consuming both substances at moderate-to-high levels score significantly lower at both the outset and across the 2-year investigation period. Our follow-up analysis also indicate that when students curtailed their substance use over time they had significantly higher academic GPA compared to those who remained stable in their substance use patterns over the two year period.ConclusionsOverall, our study validates and extends the current literature by providing important implications of concurrent alcohol and marijuana use on academic achievement in college.

Alcohol intake and mortality among survivors of colorectal cancer: The Cancer Prevention Study II Nutrition Cohort.

Alcohol consumption is associated with a higher risk of colorectal cancer, but to the authors' knowledge its influence on survival after a diagnosis of colorectal cancer is unclear. The authors investigated associations between prediagnosis and postdiagnosis alcohol intake with mortality among survivors of colorectal cancer. The authors identified 2458 men and women who were diagnosed with invasive, nonmetastatic colorectal cancer between 1992 (enrollment into the Cancer Prevention Study II Nutrition Cohort) and 2011. Alcohol consumption was self-reported at baseline and updated in 1997, 1999, 2003, and 2007. Postdiagnosis alcohol data were available for 1599 participants. Of the 2458 participants diagnosed with colorectal cancer, 1156 died during follow-up through 2012. Prediagnosis and postdiagnosis alcohol consumption were not found to be associated with all-cause mortality, except for an association between prediagnosis consumption of <2 drinks per day and a slightly lower risk of all-cause mortality (relative risk [RR], 0.86; 95% confidence interval [95% CI], 0.74-1.00) compared with never drinking. Alcohol use was generally not associated with colorectal cancer-specific mortality, although there was some suggestion of increased colorectal cancer-specific mortality with postdiagnosis drinking (RR, 1.27 [95% CI, 0.87-1.86] for current drinking of <2 drinks/day and RR, 1.44 [95% CI, 0.80-2.60] for current drinking of ≥2 drinks/day). The results of the current study do not support an association between alcohol consumption and all-cause mortality among individuals with nonmetastatic colorectal cancer. The association between postdiagnosis drinking and colorectal cancer-specific mortality should be examined in larger studies of individuals diagnosed with nonmetastatic colorectal cancer. Cancer 2017;123:2006-2013. © 2017 American Cancer Society.

Ethanol Induces Platelet Apoptosis

Alcohol abuse incurs severe medical conditions, such as thrombocytopenia and hemorrhage, but the pathogenesis is not totally understood. Alcohol has been reported to induce apoptosis in eukaryotic cells, such as hepatocyte, nerve cell, corneal fibroblasts. However, it is still unclear whether alcohol induces platelet apoptosis. Washed human platelets were pretreated with ethanol (EtOH), and apoptotic events and platelet function were detected. In invivo experiments, C57BL/6J mice were given EtOH by gavage. Platelet counts, tail bleeding time, and the stomach were examined. EtOH dose dependently induces depolarization of mitochondrial inner transmembrane potential, up-regulation of Bax, down-regulation of Bcl-2, and caspase-3 activation. EtOH does not induce surface expression of P-selectin or PAC-1 binding, whereas significantly reduces collagen-, thrombin-, and ADP-induced platelet aggregation. Moreover, EtOH induces c-Jun NH2-terminal kinase activation. In an invivo mouse model of the acute alcoholism, EtOH significantly reduces the number of circulating platelets, prolongs the tail bleeding time, and causes gastric mucosa hemorrhage. These data demonstrate that EtOH induces mitochondria-mediated intrinsic platelet apoptosis, results in the reduction of the number of circulating platelets, and impairs invivo hemostasis. These findings reveal the possible pathogenesis of hemorrhagic symptoms in patients experiencing acute alcohol intoxication.

Alcohol consumption among adults in Bangladesh: Results from STEPS 2010.

Background Alcohol use is a risk factor for the development of noncommunicable diseases. National data are needed to assess the prevalence of alcohol use in the Bangladeshi population. The objective of this study was to describe the prevalence and patterns of alcohol use among men and women of rural and urban areas of Bangladesh. Additionally, predictors of ever alcohol use were also identified. Methods A nationally representative cross-sectional survey (STEPS 2010) was conducted on 9275 adults between November 2009 and April 2010. Participants were selected using multi-stage random cluster sampling. Data on several risk factors for noncommunicable diseases, including alcohol use, were collected by an interviewer-administered questionnaire. Results Among the total population, 5.6% (n = 519) reported to have ever drunk alcohol and 94.4% (8756) were lifetime abstainers; 2.0% (n = 190) of participants reported to have drunk alcohol within the last 12 months. Of these, 94.7% (n = 180) were men. Only 0.9% (n = 87) of the total population had drunk alcohol within the last 30 days and were categorized as current drinkers. Among current drinkers, 77.0% (n = 67) were defined as binge drinkers, having had at least one episode of heavy drinking in this time period; 92.0% (n = 80) were current smokers and 59.8% (n = 52) had either no formal education or less than primary school education. Ever alcohol use was more common among men, those who live in urban areas and smokers. Conclusion Alcohol use is low in Bangladesh; however, those who do use alcohol frequently binge drink, which is a public health concern. Targeted efforts should be made on these specific groups, to control and prevent the continued use of alcohol in Bangladesh.

Alcohol use in the prehospital setting: a diagnostic challenge in patients treated by a physician staffed mobile intensive care unit.

Background Alcohol use among emergency patients has been studied earlier, but the data regarding alcohol use especially among critically ill and injured patients treated in the prehospital setting is scarce. The aim of this study was to evaluate the incidence of alcohol use and the characteristics of cases attended by a physician staffed mobile intensive care unit (MICU).FindingsDuring a 2 month period, exhaled air alcohol concentration—measured as a part of routine patient examination in all adolescent and adult patients treated by the MICU—was recorded. The MICU encountered 258 patients, of which 82 could be tested for alcohol use. Of the tested patients 43 % gave a positive breath test result. Proportion of male patients providing a positive result in the breath test did not differ significantly those of women. The primary reason for not to test the patient was a decreased level of consciousness in one-fifth of the initial 258 patients.ConclusionsA significant proportion (47 %) of the encountered patients could not be tested due to their critical condition. Alcohol use was observed in 43 % of those capable of providing a breath test sample. The rate of positive tests seemed to be higher than those reported from emergency departments. Novel diagnostic methods to detect alcohol consumption in non-cooperative patients are warranted.

Predictors of Outcome After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: An Echocardiography and Cardiovascular Magnetic Resonance Imaging Study.

Alcohol septal ablation (ASA) is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe left ventricular outflow tract (LVOT) obstruction. The current recommendations restrict the procedure to adults with favorable anatomy and no other coexisting surgically amenable disease. Some patients remain symptomatic with residual LVOT obstruction, thus better patient selection is required. One-hundred and two consecutive subjects with hypertrophic obstructive cardiomyopathy who underwent cardiovascular magnetic resonance imaging, transthoracic echocardiography, and ASA were enrolled in this study. Successful ASA was defined as reduction of LVOT gradient ≥50% of baseline by echocardiographic follow-up 6 months post ASA. The relationships between segmental thickness assessed by cardiovascular magnetic resonance imaging and echocardiography and outcomes of ASA were compared between the 2 groups. The survival rate after ablation was 100% at 6-month follow-up. The LVOT gradient decreased ≥50% of baseline in 72% (73/102) patients. There were good correlations between the reduction of postoperative LVOT gradient and the thickness of basal anterior segment (r=0.371; P<0.001), basal anteroseptal segment (r=0.527; P<0.001), and total thickness of the above 2 segments (r=0.672; P<0.001). The area under the receiver operating curves were 0.68, 0.79 and 0.89 for predictive analysis (all P<0.001). The cutoff thickness of the segment 1+2 was 50.9 mm, which yielded a sensitivity of 86% and specificity of 77%. Both echocardiography and cardiovascular magnetic resonance imaging can be used effectively as noninvasive tools for patient selection for ASA procedure. A significantly thickened septum among hypertrophic obstructive cardiomyopathy patients may be associated with a poor outcome after ASA.

Alcohol intake and Helicobacter pylori infection: a dose–response meta-analysis of observational studies

Background Alcohol intake has been suggested to have an impact on the development of many chronic diseases. How alcohol intake may modulate risk of Helicobacter pylori (H. pylori) infection, however, remains a subject open for investigation. A dose–response meta-analysis was performed of epidemiological studies to better quantify this relationship. Materials and methods Twelve observational articles were identified. The summary odds ratio (OR) and confidence intervals (CI) were calculated for alcohol drinkers vs non-drinkers. The summary OR estimates were obtained using the random-effects model and dose–response meta-analysis. Sub-group and sensitivity analysis were also conducted. Results The summary OR was 0.78 (95% CI = 0.69–0.89). The dose–response analysis demonstrated that for drinkers of 10, 15, 30, 60 and 96 g/day alcohol intake, the estimated ORs were 0.80 (95% CI = 0.76–0.85), 0.79 (95% CI = 0.75–0.84), 0.83 (95% CI = 0.78–0.87), 0.85 (95% CI = 0.78–0.93) and 0.87 (95% CI = 0.70–1.06), respectively, compared to non-drinkers. The inverse relationship between alcohol intake and H. pylori infection was consistent, regardless of sex, age, geographic areas, detection methods or beverage types. Conclusion: Evidence from these observational studies suggests that moderate alcohol intake is associated with a reduction in H. pylori infection of ∼ 22% and may facilitate elimination of H. pylori.

WITHDRAWN: S-adenosyl-L-methionine for alcoholic liver diseases.

Background Alcohol is a major cause of liver disease in the Western world today. S-adenosyl-L-methionine (SAMe) acts as a methyl donor for all known biological methylation reactions and participates in the synthesis of glutathione, the main cellular anti-oxidant. Randomised clinical trials have addressed the question whether SAMe has any efficacy in patients with alcoholic liver diseases. Objectives The objectives were to assess the efficacy of SAMe on mortality, clinical symptoms, complications, liver biochemistry, and liver histology in patients with alcoholic liver diseases. Adverse events were also analysed. Search strategy The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Library, MEDLINE, EMBASE, and full text searches were combined. Selection criteria Randomised clinical trials studying patients with alcoholic liver diseases were included. Interventions encompassed peroral or parenteral administration of SAMe at any dose versus placebo or no intervention. The trials could be double blind, single blind, or unblinded. The trials could be unpublished or published as an article, an abstract, or a letter, and no language limitations were applied. Data collection and analysis All analyses were performed according to the intention-to-treat method. The statistical package (RevMan and MetaView) provided by the Cochrane Collaboration was used. The methodological quality of the randomised clinical trials was evaluated by components of quality and the Jadad-score. Main results Eight placebo-controlled randomised clinical trials including a heterogeneous sample of 330 patients with alcoholic liver disease were identified. Only one trial including 123 patients with alcoholic cirrhosis used adequate methodology and reported clearly on mortality and liver transplantation. It demonstrated no significant effects of SAMe on mortality (Peto odds ratio (OR) 0.53, 95% confidence interval (CI) 0.22 to 1.29), liver related mortality (OR 0.63, 95% CI 0.25 to 1.58), mortality or liver transplantation (OR 0.47; 95% CI 0.20 to 1.09), or patients without complications (OR 0.63, 95% CI 0.30 to 1.31). SAMe was not significantly associated with adverse events (OR 3.95, 95% CI 0.77 to 20.24). Reviewer's conclusions This systematic review could not demonstrate any significant effect of SAMe on mortality, liver related mortality, mortality or liver transplantation, and liver complications of patients with alcoholic liver disease. SAMe should not be used for alcoholic liver disease outside randomised clinical trials.

Challenges and opportunities in alcohol screening and brief interventions in new settings: A Narrative Review of Implementation Initiatives

Background Alcohol screening and brief interventions (SBI) have a history and good evidence of efficacy in primary care settings [1]. Efficacy evidence is variable across other settings and much is unknown including mechanisms of action, and optimal screening or implementation approaches [2,3]. Despite this, implementation outside of primary care has had much attention including in non-health settings, particularly in the UK [4-6]. This study aimed to discuss, and present for debate, challenges and opportunities relating to alcohol SBI in new settings from published and previously unpublished studies of recent SBI implementation in Scotland and England.

A screening and brief intervention for women in OB/GYN care

Background Alcohol consumption levels in Russia are among the highest in the world [1]. Fetal Alcohol Spectrum Disorders in children are completely preventable by avoiding alcohol use during pregnancy [2]; yet, substantial numbers of women around the world consume alcohol during pregnancy mostly prior to pregnancy recognition [3-5]. A U.S. prevention model, Project CHOICES, utilized a pre-conceptional approach consisting of four counseling sessions and a family planning clinic visit [6]. A brief intervention protocol [7] and the CHOICES were adapted by the research team to design a brief intervention for implementation in public OB/GYN clinics in two regions in Russia. The objective of this study was to evaluate impact of the adapted protocol in reducing the risk for alcohol-exposed pregnancies (AEP) and alcohol consumption in general.