Seasonality and Delirium Tremens in Hospitalized Patients with Alcohol Dependence Syndrome.

INTRODUCTION: Due to the high rate of mortality, recognizing the contributing factors of alcohol-related delirium tremens (DT), which is the most severe form of alcohol withdrawal state (AWS) is pivotal in clinical settings. Previous studies suggested relationship between seasonality and other types of delirium; however, to our knowledge, this is the first empirical study which examined the role of seasonality in DT in alcohol dependence syndrome (ADS). METHODS: A retrospective study was undertaken between 2008 and 2015; medical records of 1,591 patients were included, which yielded 2,900 hospital appearances. Three groups were formed based on the ICD-10 diagnoses: ADS, AWS, and DT. The characteristics of the groups were analysed with one-way ANOVA and χ2 tests. Multinomial logistic regression was used to explore the potential predictors of DT, including seasonality. RESULTS: The highest incidence of DT was in spring (36.8%; χ2 (3) = 27.666; p < 0.001), especially in March (13.9%; χ2 (11) = 33.168; p < 0.001). Spring, higher mean age, higher presence of comorbid somatic disorders, and lower occurrence of comorbid psychiatric disorders were significant predictive variables for DT with the control of socio-demographic and clinical variables. CONCLUSIONS: The present study revealed that spring, especially March is a critical period in temperate climate zone regarding DT. This can be interpreted as a late winter effect since the temperature is lower in this month compared to other spring months. Furthermore, higher age and the occurrence of comorbid somatic disorders can be considered as risk factors in case of DT. These results support the need of further clinical studies to better understand the impact of seasonality on DT.

[Occult inguinal-hernia in athletes]. / Sportolók occult lágyéksérve.

INTRODUCTION: The occult inguinal hernia in athletes represents a distinct entity as well as a part of a syndrome known as PIPS (public inguinal pain syndrome). It may be relatively difficult to identify the possible source of inguinal pain, since the spectrum is so wide that it can overlap various medical subspecialties. PATIENTS AND METHODS: This study includes 14 cases of athletes (11 football players) with suspicion of occult inguinal hernia. All of them complained of suprapubic pain on physical activity which was relieved at rest. No hernia was found on physical examination in either patient. Ultrasonography of the region demonstrated protrusion of the posterior abdominal wall by increased intraabdominal pressure (such as coughing) in 12 cases. Diagnostic laparoscopy was performed in every case, and we found 13 medial and 1 femoral hernia, i.e. a hernia was identified in all patients. Laparoscopic hernia repair with TAPP (transabdominal preperitoneal) technique was carried out in every case. RESULTS: Patients were discharged 2-3 days after surgery without any postoperative complication. A gradual increase in physical activity was advised up to the limit of complaints commencing 7-10 days later. All patients could return to competitive sports after 4-6 weeks. CONCLUSION: Differential diagnosis of inguinal pain in athletes includes occult inguinal hernia, which can be diagnosed with laparoscopy and TAPP repair can be carried out at the same time, if needed, to fix it.