Histomorphological Spectrum of Lung Lesions at Autopsy-A Tertiary Care Centre Experience

Background and aims: A wide variety of pathological conditions involve the lungs. In autopsy, the lungs are examined for disease, injury and other findings suggesting cause of death or related changes.Aims & Objectives: The present study aimed to study the histomorphological spectrum of lung lesions at autopsy and to assess the frequency of different types of lesions;and to associate histomorphological changes with cause of death.Material and Methods: It was a one-year observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. Lung tissue pieces from all medicolegal autopsies received were fixed, examined grossly, processed;paraffin embedded sections obtained were stained with Hematoxylin and Eosin stain and examined under microscope. Findings were recorded and tabulated. Result(s): Out of 264 cases, males were predominantly affected (84%);median age was 38 years. The various changes observed were congestion (68%), edema (45.4%), pneumonia (5%), granulomatous inflammation (3%), diffuse alveolar damage (1.5%), haemorrhage (14.4%), interstitial changes (60%), malaria (0.4%) and malignancy (0.4%). Natural deaths were the commonest cause (75, 28%) followed by asphyxial deaths (65, 24.6%). Conclusion(s): Histopathological examination of lung autopsies highlights many incidental findings, establishes underlying cause of death, serves as a learning tool and also holds scope for detection of newer diseases.Copyright © 2023 JK Science.

Scientometric analysis of methanol intoxication literature: Global publication output between 1980 and 2019

Aim: Scientometrics refers to the analysis of scientific literature related to a certain field. Even though the number of publications on methyl alcohol poisoning has recently increased, there has been no bibliometric or scientometric analysis conducted to date. In 2020 in particular, cases of methyl alcohol poisoning have increased due to the COVID-19 pandemic, which is expected to draw greater attention to this field. Material(s) and Method(s): All data used in this study were collected from four databases accessed via the Web of Science. All studies published between 1980 and 2019 identified by searching for the keywords "methanol" and "poisoning" were included in the study. The relationship between the number of publications and productivity and characteristics of countries was analyzed with Spearman's correlation test, while GunnMap and VOSviewer were used to create infographics and infomaps. This study was conducted in accordance with the Declaration of Helsinki Results: A total of 744 articles, most of which were original (79.70%), were identified from the four databases accessed via the Web of Science. An analysis of the number of publications by country ranked the United States in the first place, with 174 articles (23.387 %), while the Czech Republic was found to have the most productive researchers. The most popular area was toxicology (20.565%), and Charles University was the most productive institution. It was found that the number of publications and citations did not increase over the years Discussion: The developed countries dominated the literature on methyl alcohol poisoning. It was further observed that articles on methyl alcohol abuse started to appear in 2020 in developing countries, which can be attributed to the COVID-19 pandemic, and the mistaken belief that it has anti-viral properties. Since the diagnosis and treatment of methyl alcohol poisoning are gaining significance, we recommend that researchers be encouraged to make further studies in this area.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Effect of Alcohol Intoxication in the Emergency Department on Suicide Mortality

Introduction: Suicide represents a significant worldwide disease burden disproportionately affecting younger patients in their prime working years. Mortality by suicide remains within the five leading causes of death up to the age of 60. Compounding this, alcohol use disorder (AUD) is known to be a risk factor for death by suicide and has been on the rise over the last 20 years, particularly during the COVID-19 pandemic. The emergency department (ED) is often the first point of health care contact for those patients that have suicidal thoughts or behaviours and understanding their acute risk of death by suicide when presenting intoxicated with alcohol remains a challenge for ED physicians. While the chronic disease of AUD elevates their lifetime risk for death by suicide, it has not been established how a presentation for suicidality accompanied by acute alcohol intoxication affects this risk. Method(s): This was a retrospective cohort study using population-based linked health administrative data for adult patients aged 18 or above who presented to Alberta (ED) between 2011 and 2021 for suicidal attempt or self-harm behavior. Patients who were acutely intoxicated with alcohol were identified and analyses compared patients with and without alcohol intoxication. The primary outcome was six-month death by suicide. Categorical variables were summarized using proportions, whereas continuous variables were summarized using means and standard deviations (SD) or medians and interquartile ranges (IQR), as appropriate. Competing risk analysis was performed to explore the cumulative incidence of death by suicide within 180 days after their index ED visit and examine the association between death by suicide and alcohol intoxication. Result(s): Patients presenting to the ED for suicide attempt or self-harm behaviour were intoxicated with alcohol in 30% of cases as determined by diagnostic coding and blood alcohol measurements. Intoxicated patients were more likely to be placed under involuntary mental health hold (26% vs 16%) and had on average a longer length of stay in the ED (411 min vs 277 min) but were less frequently admitted (10.8% vs 15.4%). As a departure from previous literature, those intoxicated with alcohol were more likely to be consulted to psychiatry (15.8% vs 12.6%). Mortality due to suicide in the 6 months following the patient' index ED visit were similar between the intoxicated and non-intoxicated groups (0.3% vs 0.3%) however there was a significant increase in all-cause mortality at 6 months in the nonintoxicated group (1.5% vs 2.1%). Discussion(s): This study examined the patient and ED treatment characteristics of patients presenting to the ED with suicide attempt or self-harm behaviour. It found that the 6-month risk of death by suicide was no different in those who presented with acute alcohol intoxication vs those without. While these results differ from other studies discussing how alcohol use disorder confers a chronically increased risk of death by suicide, they provide new evidence for the emergency department providers to consider when assessing the patient who presents with suicidal behaviours while intoxicated.

PREVALENCE AND MORTALITY OF ALCOHOL-RELATED LIVER DISEASES DURING COVID-19 PANDEMIC

Background COVID-19 pandemic and its resulting life stress could affect lifestyle including increased alcohol use. Mounting evidence has indicated rising prevalence in alcohol related liver disease (ALD) during pandemic. However, the studies were limited by single center data with cross-sectional design. We aimed to determine the nationwide effect of COVID- 19 pandemic on the prevalence as well as mortality of ALD among patients with alcohol use disorder (AUD). Methods Patient data were obtained from the Optum de-identified Clinformatics® database. Enrollees with a diagnosis of AUD who received care in hospital emergency department and/or inpatient service from January 2019 to December 2020 were included and followed up until March 2021. AUD were defined as having alcohol intoxication, withdrawal, and alcohol-related mental health disorders. We estimated the quarterly prevalence and 30-, 60-, 90-, and 180-day mortality during study period. Results There were no significant trends in mortality before the pandemic. The 30-day mortality decreased from 11.96% to 10.34% from Q1 to Q3 in 2019, then increased to 12.10% in Q1 2020. The increase between 2019 Q1 and 2020 Q1 was not significant. In contrast, the mortality rates increased from 2020 Q1 to 2020 Q2 and continued to increase during pandemic. Mortality rate elevated from 12.10% to 13.44% from 2020 Q1 to 2020 Q2, followed by 13.50% in Q3 and 14.94% in Q4. Similar pattern was seen in 60-day and 90-day mortalities. About a quarter of patient died at 90 days after diagnosis of ALD. The prevalence of ALD among patients with AUD fluctuated throughout 2019, with 53.77% in 2019 Q1 decreasing to 51.29% in 2019 Q3. It increased to 53.15% in 2019 Q4. The prevalence was higher in 2020 Q1 compare to 2019 Q1. However, during pandemic, the prevalence decreased to 53.98% in 2020 Q2 then bounced to 55.40% and 56.57% in 2020 Q3 and Q4. While the prevalence of ALD in AUD patients who visited ED increased from 2020 Q2 to 2020 Q4, the prevalence of ALD in hospitalized patient surged in 2020 Q2, followed by decreasing trend in latter half of 2020. The increasing trend was more prominent in patients aged <65 years than those $65 years. Males had a steeper increasing trend than females. While there was no significant change in prevalence of ALD among non-Hispanic Asians, the upward trend among non-Hispanic Whites and Blacks was significant. ConclusionsWedemonstrated an alarming rise in ALD mortality and increased prevalence among patients with AUD. The data were derived from patients with private insurance. Trends in those without insurance or less coverage are expected to be more alarming given the limitation in access to care. There were significant disparities by sex and race and ethnicity that may inform stakeholders for targeted interventions and resource allocation to curb the surging burden of ALD during pandemic. (Table Presented)

DIFFERENCES IN ACUTE ALCOHOL-RELATED HEALTHCARE UTILIZATION COMPARING BEFORE AND DURING THE COVID-19 PANDEMIC

Background: Data have shown an increase in alcohol use during the COVID-19 pandemic in North America. While the total number of emergency department (ED) visits decreased during the early pandemic, some studies show that the proportion of alcohol-associated visits increased during this time. There is otherwise a paucity of data on how potentially increased alcohol use during the pandemic has affected healthcare utilization and patient outcomes, especially in patients with liver disease. Methods: Clinical records from a tertiary hospital in Ontario, Canada were reviewed for all adult patients encounters in the ED, urgent care, or inpatient setting for alcohol-associated reasons between April 2019 and October 2019 (pre-pandemic cohort) and between April 2020 and October 2020 (pandemic cohort). Data collected included: age, sex, marital status, rurality and socioeconomic status (by postal code-linked national census data), medical history, alcohol consumption habits, use of medications for alcohol use disorder, alcohol-associated diagnosis (based on ICD-10 code), need for intensive care unit admission, consultations made, discharge disposition, and laboratory results. Bivariate chi-squared analysis was performed to compare data from the pre-pandemic and pandemic cohorts. Results: 528 records in the pre-pandemic cohort and 490 records in the pandemic cohort were ed and summarized (Tables 1 and 2). As compared with the pre-pandemic cohort, patients during the pandemic presenting with alcohol-associated diagnoses were older (43 years, IQR 31-57 vs. 38 years, IQR 24-55;p<.001), more likely to be male (66% vs. 55%;p=.001), have a prior history of habitual heavy alcohol use or alcohol use disorder (77% vs. 63%;p<.001), have a history of a psychiatric disorder (56% vs 46%;p=.003), and to have been previously prescribed medication for alcohol use disorder (18% vs. 5%;p<.001). In the pandemic cohort, there was a greater proportion of encounters for alcohol withdrawal (32% vs. 22%;p=.001), a lower proportion of encounters for alcohol intoxication (46% vs. 56%;p<.001), and a similar proportion of encounters for alcohol-associated liver disease (8% vs. 7%;p=.651) compared to the pre-pandemic cohort. Conclusion: Our data show differences in patient characteristics for patients presenting to hospital for alcohol-associated reasons during the COVID-19 pandemic. As compared with the year before the pandemic, patients were older, more often male, and more likely to have history of psychiatric disorders or heavy alcohol use. One concerning finding was a significant rise in alcohol withdrawal, which could potentially be due to increased consumption of alcohol during the pandemic. These data raise concern for an increase in prevalence of alcohol-associated liver disease in the future, highlighting the need for enhanced alcohol addiction services. (Table Presented)

Conformity to Masculine Norms and Men's Responses to the COVID-19 Pandemic

Public Significance Statement The study examined men's conformity to specific masculinity norms to predict their adherence to Centers for Disease Control and Prevention (CDC) recommendations for combatting COVID-19 and their attitudes toward mask wearing. The findings can aid in public health efforts to improve men's participation in combatting the pandemic and future public health crises. The study examined men's conformity to masculine norms as related to adherence to Centers for Disease Control and Prevention (CDC) recommendations for mitigating the spread of COVID-19 as well as men's attitudes toward mask wearing. Five hundred eighty nine participant men, predominantly White and heterosexual, completed the 10-15 min anonymous online survey through Prolific. After controlling for demographics, results indicated that the masculine norms of emotional control and power over women were related to less adherence to CDC recommendations;and that self-reliance, power over women, and heterosexual self-presentation were related to more negative attitudes toward mask wearing. Limitations and future research such as improving men's participation in combatting COVID-19, and other public health crises, by addressing men's specific salient masculine norms when developing and implementing public health outreach and prevention are discussed.

Suicidal ideation and sobriety: Should acute alcohol intoxication be taken into account for psychiatric evaluation?

BACKGROUND: When evaluating an emergency department (ED) patient who presents with suicidal ideation, it is a common practice to wait until the patient's ethanol level is known or calculated to be less than 80 mg/dl to evaluate patient safety. We know of no study that establishes an association between the degree of alcohol intoxication based on a blood alcohol level (BAL) and reported suicidal ideation (SI) upon recovery. METHODS: We conducted a retrospective review of patients evaluated in a Midwestern ED for the calendar year 2017. Cases were selected if they had a psychiatric social work consult and a blood alcohol level drawn while in the ED. Patients were selected on the same 2 days each week throughout the year to meet the sample size requirements of the study, resulting in 1084 cases for review. Chi-square analysis was used to evaluate the relationship between suicidal ideation and alcohol intoxication as defined by a BAL ≥80 mg/dl. RESULTS: Among patients presenting with suicidal ideation and a concurrent BAL ≥80 mg/dl, 69% no longer reported suicidal ideation when their BAL was <80 mg/dl, compared to 38% for patients without a positive BAL on presentation (chi-square, p = 0.000012). CONCLUSION: Our data show that patients presenting to the ED with complaints related to suicidal behavior who have a BAL ≥80 mg/dl are more likely to no longer endorse having suicidal ideation once their BAL is < 80 mg/dl than patients with similar presenting complaints and no alcohol intoxication. This finding supports the common ED practice of re-assessing suicidal ideation among individuals who are initially intoxicated once their BAL has decreased below 80 mg/dl.

Effects of the 2020 health crisis on acute alcohol intoxication: A nationwide retrospective observational study.

BACKGROUND: Recent data suggest that the COVID-19 pandemic and associated restrictions may have influenced alcohol use and promoted addictive behavior. We aimed to investigate the impact of the pandemic on acute alcohol intoxication (AAI) in France. METHODS: We identified all hospital stays related to alcohol abuse in 2018-2020. Differences in number of hospitalizations between 2019 and 2020 were tested using Poisson regressions. Differences between observed and expected deliveries of drugs used in alcohol dependence in 2020 were also studied. RESULTS: There was a decrease in the number of hospitalizations for AAI between 2019 and 2020 (-9677[-11·4%],RR:0·89[0·88-0·89]). This decrease was observed among men and women of all age groups, except women ≥ 85 years. We observed an increase in in-hospital mortality during 2020 and more hospitalizations for AAI with certain medical complications, especially during the first 2020 lockdown. There was a drop in observed deliveries of drugs used in alcohol dependence during the first 2020 lockdown. CONCLUSIONS: The decrease in the number of hospitalizations for AAI in 2020 could be explained by several factors: fewer available hospital beds due to COVID-19, individuals with AAI delaying or avoiding medical care due to COVID-19 fears, and decreases driven by younger age groups returning to live with parents and socializing less. While alcohol consumption patterns have changed with the implementation of social distancing measures and lockdowns, the increase in mortality and the share of hospitalizations with complications suggest that these measures had an impact on event severity in a context of strained access to healthcare.

Acute Alcohol Intoxication in Dutch Adolescents Before, During, and After the First COVID-19 Lockdown.

PURPOSE: The association between acute alcohol intoxication among adolescents and the COVID-19 lockdown has been studied previously in Trieste, Italy. They recommended that emergency services should be prepared for a potential peak of alcohol intoxication-related emergencies among adolescents as a result of the COVID-19 lockdown. Therefore, this study investigated the influence of the COVID-19 pandemic on the prevalence of acute alcohol intoxication among adolescents in the Netherlands. METHODS: To determine both the prevalence and characteristics of adolescents admitted for acute alcohol intoxication in 2019-2020, a retrospective cohort study was conducted. All adolescents <18 years of age admitted for acute alcohol intoxication in the 12 participating hospitals in the Netherlands in 2019-2020 were included. Adolescents were divided in periods before, during, and subsequent to the first COVID-19 lockdown and the beginning of the second lockdown, in comparison with the same periods in 2019. RESULTS: The prevalence of acute alcohol intoxication among adolescents decreased by 70% during the first lockdown (March 16-May 31, 2020) compared with the period before lockdown (January 1-March 15, 2020). Between the first lockdown phase and the reopening period (June 1-October 14, 2020), the prevalence significantly increased. CONCLUSIONS: This study demonstrates that COVID-19 lockdown led to a decrease in acute alcohol intoxication among adolescents. This decrease is multifactorial, including the closure of bars/restaurants, sport clubs, schools and increased parental supervision due to obligatory working from home of parents. Based on the findings, this specific population requires close monitoring, especially in the reopening phases.

Trends of Hospitalization for Acute Alcohol Intoxication in Slovenian Children and Adolescents with and without Dual Disorder. Implications for a Correct Intervention.

BACKGROUND: Binge drinking and other forms of ethanol abuse are, when present, a serious problem in preteens and adolescents worldwide. AIM: The present study has analyzed the trend in alcohol-related intoxications requiring the hospitalization of children, adolescents and young adults aged less than 21 years in Slovenia in the 1999-2018 period. METHODS: We performed a retrospective study on patients discharged after hospitalizations due to mental and behavioral disorders due to acute alcohol intoxication (MBDAAI) or hospitalizations due to the toxic effects of alcohol (TEA We considered three groups: children (aged 10-14), adolescents (aged 15-19) and young adults (20-21 years old). Hospitalization rates and time trends were analyzed using joinpoint regression to obtain the annually calculated age- and sex-specific rates and the annual percentage of change (APC). RESULTS: Considering a total of 2912 MBDAAI-hospitalizations, 15-19-year-old subjects showed a significantly higher hospitalization rate compared to the immediately younger and older age groups and a significant increase in hospitalization rates in the period 1999-2011, followed by a significant decrease. Considering 1143 TEA-hospitalizations, we observed a continuous decrease in the hospitalization rates for children and young adults and, conversely, a continuous even if less than significant increase for adolescents aged 15-19. CONCLUSIONS: Alcohol consumption in Slovenian children and adolescents is a highly important health concern. Special attention to public health problem of severe alcohol abuse requiring hospitalization in children and adolescents is needed, especially with possible crisis of SARS-CoV-2/Covid-19 situation.