Alcohol intoxication and lack of helmet use are common in electric scooter-related traumatic brain injuries: a consecutive patient series from a tertiary university hospital

Purpose Clinicians have increasingly encountered traumatic brain injuries (TBI) related to electric scooter (ES) accidents. In this study, we aim to identify the modifiable risk factors for ES-related TBIs. Methods A retrospective cohort of consecutive patients treated for ES-related traumatic brain injuries in a tertiary university hospital between May 2019 and September 2021 was identified and employed for the study. The characteristics of the accidents along with the clinical and imaging findings of the injuries were collected from the patient charts. Results During the study period, 104 TBIs related to ES accidents were identified. There was a high occurrence of accidents late at night and on Saturdays. In four cases, the patient’s helmet use was mentioned (3.8%). Seventy-four patients (71%) were intoxicated. At the scene of the accident, seventy-seven (74%) of the patients had a Glasgow Coma Scale score of 13–15, three patients (3%) had a score of 9–12, and two patients (2%) had a score of 3–8. The majority (83%) of TBIs were diagnosed as concussions. Eighteen patients had evidence of intracranial injuries in the imagining. Two patients required neurosurgical procedures. The estimated population standardized incidence increased from 7.0/100,000 (95% CI 3.5–11/100,000) in 2019 to 27/100,000 (95% CI 20–34/100,000) in 2021. Conclusions Alcohol intoxication and the lack of a helmet were common in TBIs caused by ES accidents. Most of the accidents occurred late at night. Targeting these modifiable factors could decrease the incidence of ES-related TBIs.

CHARACTER AND FREQUENCY OF COMPLICATIONS IN PATIENTS WITH POLYTRAUMA AND CHRONIC ALCOHOL INTOXICATION

Purpose. Identify patterns of traumatic disease and characterize complications in patients with polytrauma (PT) and chronic alcohol intoxication (CAI). Materials and methods. Case histories of 39 victims with PT and alcohol history at age 19-60 years who were undergoing treatment at the Prof. Meshchaninov Kharkov City Clinical Emergency Hospital in 2016. Patient inclusion criteria: age 19-60, damage of two or more anatomical functional areas, severity of traumatic injury on the ISS scale 9-25 points, Glasgow coma scores ≥14 at the time of admission, absence of craniocerebral trauma, the absence of general anesthesia. Results. The average age of patients was 37.4 ± 9.4 years. Among these groups of patients were 29 men (74%), which is 2.9 times the number of women 10 (26%). Attention is drawn to the fact that the most important part of the victims (28.2%) was precisely the patients of the young able-bodied age. Infectious complications that developed in the early and late period of traumatic disease in victims with CAI are the main causes of death in PT - patients and induce a negative prognosis for survival. During analyzing the timing of the development of purulent-septic complications in this group of patients, we came to the conclusion that they occur on average at 7.2 ± 2.4 days. Among the infectious complications of PT in patients with CAI were pneumonia (28.2%), sepsis (7.6%), peritonitis (7.6%), pleural empyema (5.1%), osteomyelitis (5.1%). Non-infectious complications, in contrast to infectious, manifested from the first hours of injury and reached maximum development during the period by 2.3 ± 0.8 days, they were the main trigger for the development of severe infectious complications in the early period of traumatic disease. Noninfectious complications were consisted by delirium - in 29 patients, which increased the patients duration at intensive care unit on 39,6 ± 5 3 hours. These complications significantly increased the severity of the PT patients with CAI. With a higher incidence, it occurred in hyperactive, (62%) patients with delirium, and mixed (38%) form. Attention is drawn to the fact that patients with fatal outcome (29 cases), delirium was observed significantly more frequently (χ2 to include Yeats = 3.641, p <0.05) was found in 25 patients. Less frequently in patients occurred thrombosis 5(12.8%) and fat embolism syndrom 2 (5.1%). Conclusions. Most often, multiple injuries with history of alcohol use are obtained by young working aged men. The cause of injury in more than 60% of cases is accidents. 82% of the victims were in the state of alcohol intoxication during their hospitalization. On average, the terms of stay of patients with ICU are 64.9 ± 23.7 hours, although with the development of complications, these terms increase to 103.2 ± 14.2 hours. In patients with CAI there is a complicated course of traumatic disease. Among the infectious complications that develop at 7.2 ± 2.4 days, pneumonia, sepsis and peritonitis predominate. The most common non-infectious complications were delirium, thrombophlebitis thrombosis, fat embolism. Risk of fatal outcome in patients with delirium in 6.25 times higher than in patients without acute encephalopathy. Thus, the treatment of patients with a history of with polytrauma and chronic alcohol intoxication is an extremely important medical problem that needs further study and improvement.

Study of compatibility of components of a new combined drug for treatment of alcoholic intoxication and its hepatoprotective effect on a model of alcoholic liver injury

The aim of the work is the development of a combined drug for use in alcohol intoxication based on the physicochemical properties and chemical compatibility of active pharmaceutical ingredients and excipients, and the study of the hepatoprotective effect in alcoholic hepatitis in rats. Materials and methods. During the studies, physical and physicochemical methods were used, a Specord 200 spectrophotometer (Germany), analytical scales Sartorius (SARTORIUS, Germany), class A volumetric glassware and reagents that meet the requirements of the State Pharmacopoeia of Ukraine (SPhU). Alcoholic hepatitis in rats was reproduced by intragastric administration of an aqueous 40% ethanol solution at a dose of 7 ml/kg for 1 week. Results. A new combined agent is proposed for use in alcohol intoxication in the form of an effervescent powder for the preparation of an oral solution, which contains glycine, L-glutamic acid, acetylsalicylic acid, ascorbic acid, fructose / sorbitol and sodium bicarbonate and citric acid to accelerate the dissolution of medicinal substances. To study the compatibility of the components, experimental studies of hygroscopicity, chemical interaction / chemical stability and an assessment of the redox potential of the proposed active pharmaceutical ingredients were carried out. To study the stability of the API, studies were carried out on sugaramine condensation due to the choice of amino acids and ascorbic acid in the composition of drugs. Based on the research results, it was decided to divide the API into 2 packages, separating sodium bicarbonate and glycine, which can interact with ascorbic acid / acetylsalicylic acid and ascorbic acid, respectively. In an in vivo experiment, it was found that the use of the new drug is accompanied by the normalization of the antioxidant-prooxidant status of the liver due to a likely decrease in the TBA-AP level and an increase in the RG index in the liver homogenate relative to the control group. Conclusions. Evaluation of the physicochemical properties of API allowed us to propose a new combined drug (TS-PP) for use in alcohol intoxication in the form of an effervescent powder for the preparation of oral solution. In alcoholic hepatitis in rats, it was found that the use of the studied drug largely prevents the formation of the effects of the toxic effects of ethanol on the rat organism, which is manifested by inhibition of destruction of hepatocyte membranes, a decrease in the level of LPO products, restoration of the RG index and improvement of the protein synthesizing function of the liver due to the complex effect of amino acids and ascorbic acid contained in the product

Teratogenic effect of alcohol on the myocardium of laboratory animals at the stages of prenatal ontogenesis (literature review)

Background. To date, close attention is paid to the problems of formation and development of the myocardium in general and in particular its structural components. This phenomenon is associated with an increase in cardiovascular malformations in both adults and infants. These defects can be caused by genetic factors, as well as various teratogenic substances. One such substance is alcohol. Despite the risks, many women still drink alcohol during pregnancy. The main problem is that almost half of pregnancies are unplanned, so a woman may continue to consume alcohol for several weeks before learning about her condition. Especially in young women, fertilization can occur in a state of intoxication. In addition, under the influence of ethanol, cardiac function may be impaired in the absence of structural abnormalities. Chronic alcohol intoxication causes changes in the myocardium at all levels of its structural organization. First of all, teratogenic changes caused by the action of ethanol affect the development of cardiomyocytes in the process of embryogenesis, which contributes to the underdevelopment of the structure or function of heart cells. Although the effect of maternal alcohol consumption on the fetus has been studied for decades, there are still conflicting conclusions about the severity of myocardial morphological changes depending on the time, frequency and duration of alcohol consumption. Objective: to conduct a retrospective analysis of literature sources devoted to the study of adverse effects on the fetus caused by alcohol. Methods. The paper conducted a retrospective analysis of literature references and formed an understanding of the changes in the structure of the myocardium caused by teratogenic effects of alcohol. Results and conclusion. Analysis of literature sources showed a high level of adverse effects observed in offspring born to alcoholic mothers. Detrimental effects of alcohol cause changes in the myocardium at all levels of structural organization, including its ultrastructure. It was studied that prenatal exposure to ethanol induces significant changes in relative heart weight, left ventricular wall thickness and cardiomyocyte size. Exposure to high concentrations of alcohol in experimental animals during gestation can lead to congenital heart defects, such as atrial, ventricular, and septal defects. The main manifestation of the prenatal effect of alcohol after birth is the fetal alcohol syndrome, which combines various degrees of deviation in the development of the child.

Is sobriety from alcohol necessary for evaluation of patients presenting with suicidal ideation?

BackgroundIt is commonly assumed that patients intoxicated with alcohol are unreliable with respect to their statements of suicidal intent, however no prior literature evaluates the impact of sobriety on suicidal ideation (SI). In typical emergency department (ED) settings, a common practice is to wait until intoxicated suicidal individuals have reached a legally sober limit (ethanol level less than 80 mg/dL) to evaluate safety. We are not aware of any study that establishes the diagnostic reliability of the clinical suicidal ideation evaluation as a function of alcohol intoxication.MethodsThis study is a retrospective review of medical records for patients evaluated in a pre-COVID Midwestern ED for one calendar year. Cases were generated for review based on criteria of having a Psychiatric SW (Social Work) consult and blood alcohol level drawn while in the ED on every Wednesday and Friday of 2017 which produced 1084 cases for review. Chi-square analysis was used for comparison of variables of suicidal ideation with or without alcohol intoxication as defined by blood alcohol level (BAL) ≥80 mg/dL.ResultsIn reference to our initial hypothesis, patients presenting with suicidal ideation and concurrent alcohol intoxication were no longer reporting suicidal ideation at sobriety in 69% of cases, compared to 38% for patients without alcohol levels on presentation. Chi-square analysis demonstrated p=0.000012.ConclusionThe goal of the present study was to demonstrate, with empirical data, a relationship between alcohol intoxication and suicidal ideation. Our data suggests that patients presenting to the ED with complaints related to suicidal behavior who are found to have concurrent alcohol intoxication are more likely to deny suicidal ideation when sober than patients with similar presenting complaints and no alcohol intoxication.

The Relationship between Alcohol Hangover Severity, Sleep and Cognitive Performance; a Naturalistic Study

Alcohol hangover (AH) has been associated with poor sleep due to the negative effects of alcohol intoxication on sleep quantity and sleep quality. The aim of the current study was to further explore the relationship between AH severity and sleep using a naturalistic study design. A further aim was to determine whether quantitative aspects of sleep were a mediating influence on the relationship between AH severity and cognitive performance. As part of the naturalistic study design, 99 drinkers were recruited following a night of drinking in an Australian state capital, with breath alcohol concentration (BrAC) measured as participants were leaving the entertainment district. The following morning at home, participants answered online questions regarding their drinking behaviour on the previous evening, current AH symptoms and sleep quality. Participants also completed an online version of the Trail-Making Test B (TMT-B) to assess cognitive performance. The findings reveal the duration of nightly awakenings to be negatively related to six individual AH symptoms as well as overall AH severity. The number of nightly awakenings, sleep quality and total sleep time correlated with four AH symptoms including overall AH severity. Total AH severity accounted for a moderate amount of variance (11%) in the time to complete the TMT-B. These findings confirm that alcohol consumption negatively affects sleep, which is related to higher next-day hangover severity ratings and poorer cognitive performance.

Chronopharmacology of alcoholism

В статье представлен анализ информации из литературных источников, посвященной изучению хронофармакологии алкоголизма. Для лечения алкоголизма используется комплексный подход, определяющийся тяжестью состояния больного и индивидуальными особенностями симптоматики. В связи со способностью фармакологических соединений вмешиваться в течение ритмических процессов на всех уровнях организации биосистемы хронофармакологический эффект лекарственных средств может быть полезным или нежелательным. Высокой степенью осложнений со стороны сердечно-сосудистой и нервной систем, а также печени и желудочно-кишечного тракта характеризуется хроническая алкогольная интоксикация. Надежного средства патогенетической фармакотерапии алкоголизма до настоящего времени не разработано. При этом лекарственные препараты используют в основном для купирования явлений абстиненции. Одно из первых мест в терапии алкогольного абстинентного синдрома, сопровождающегося тревогой, страхом и беспокойством, занимают депримирующие средства. Однако расширение их применения в Российской Федерации для лечения алкоголизма остается необоснованным. Так как алкоголизм вызывает крайне разнообразные по своим клиническим проявлениям и по степени тяжести психические расстройства, то для их лечения используется широкий спектр психотропных препаратов. Для проведения противогипоксической и детоксифицирующей терапии используются энергокорригирующие средства. Алкогольный абстинентный синдром с преобладанием неврозоподобных и вегетативнососудистых расстройств является показанием к применению препаратов из класса антиоксидантов. Они сочетают в себе свойства транквилизаторов и ноотропов, не оказывая токсического воздействия на сердце и защищая миокард в условиях гипоксии. Однако на данный момент существует дефицит информации об эффективности их применения при алкогольной абстиненции. The article presents an analysis of information from literary sources devoted to the study of the chronopharmacology of alcoholism. For the treatment of alcoholism, an integrated approach is used, which is determined by the severity of the patient's condition and the individual characteristics of the symptoms. Due to the ability of pharmacological compounds to interfere during rhythmic processes at all levels of the organization of the biosystem, the chronopharmacological effect of drugs may be useful or undesirable. Chronic alcohol intoxication is characterized by a high degree of complications from the cardiovascular, nervous systems, liver and gastrointestinal tract. A reliable means of pathogenetic pharmacotherapy of alcoholism has not yet been developed. At the same time, medications are used mainly for the relief of withdrawal symptoms. One of the first places in the treatment of alcohol withdrawal syndrome, accompanied by anxiety, fear and anxiety, is occupied by depressants. However, the expansion of their use in the Russian Federation for the treatment of alcoholism remains unfounded. Since alcoholism causes extremely diverse mental disorders in their clinical manifestations and severity, a wide range of psychotropic drugs is used for their treatment. For antihypoxic and detoxifying therapy, energy-correcting agents are also used. Alcohol withdrawal syndrome with a predominance of neurosis-like and vegetative-vascular disorders is an indication for the use of drugs from the class of antioxidants. They combine the properties of tranquilizers and nootropics, without having a toxic effect on the heart and protecting the myocardium in hypoxia. However, at the moment there is a lack of information about the effectiveness of their use in alcohol withdrawal.