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Traumatic injuries afflict more than 5 million people globally every year. Current and past animal research has demonstrated association among alcohol, trauma, and impaired immune function, whereas human registries have shown association between alcohol and morbidity as well as mortality. The purpose of this study is to elucidate the immune interactions with alcohol in traumatically injured patients. We prospectively enrolled 379 patients after trauma at three medical centers in the Surgical Critical Care Initiative. Plasma was analyzed using Luminex for up to 35 different cytokines. Collected samples were grouped by patients with detectable plasma alcohol levels versus those without. Univariate testing determined differences in analytes between groups. We built Bayesian belief networks with multiple minimum descriptive lengths to compare the two groups. All 379 patient samples were analyzed. Two hundred eighty‐two (74.4%) patients were men, and 143 (37.7%) were White. Patients had a median intensive care unit length of stay (LOS) of 5.8 days and hospital LOS of 12 days. Using single variate analyses, eight different cytokines were differentially associated with alcohol. Cytokines IL‐12 and IL‐6 were important nodes in both models and IL‐10 was a prominent node in the nonalcohol model. This study found select immune function differed between traumatically injured patients with measurable serum alcohol levels as compared with those without. Traumatically injured patients with positive blood alcohol content appear less able to inhibit inflammatory stress. Alcohol appears to suppress pro‐inflammatory IL‐12 and IL‐6, whereas patients without alcohol have greater levels of anti‐inflammatory IL‐10 expressed at injury and may better regulate anti‐inflammatory pathways. Future studies should determine the relationship with these markers with clinically oriented outcomes.

Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14%–18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This review aims to educate clinicians on recent developments in the role of cofactors and highlight the importance of recognizing cofactors in food allergies and food-induced anaphylaxis.

Anion gap metabolic acidosis (AGMA) is common in patients presenting for emergency care. While some disease processes and ingestions are easily excluded, diagnosing toxic alcohol (TA) ingestion can be challenging. This is especially true if drug concentrations are not readily available, which forces clinicians to rely on surrogate markers. Like TA ingestion, alcoholic ketoacidosis (AKA) produces an elevated osmol gap and an AGMA. The aim of this study was to identify risk factors suggestive of AKA when TA ingestion was the primary alternative differential diagnosis. We hypothesized that the odds of an AKA diagnosis would increase as ethanol concentration increased.This was a retrospective analysis of data from 2000 through 2019 from a single US Poison Control Center. Records were reviewed to identify cases coded as "methanol" or "ethylene glycol"; or coded as "alcohol" or "ethanol with acidosis." The case definition for AKA required: (1) documented alcohol use disorder; (2) urine or serum ketones or elevated blood beta-hydroxybutyrate concentration; (3) anion gap ≥ 14 mmol/L. The inclusion criterion for TAs was a detectable methanol or ethylene glycol concentration.Of 699 patients screened, 86 were diagnosed with AKA and 36 were diagnosed with TA ingestion. As ethanol concentration increased, the odds of an AKA diagnosis significantly increased (OR = 1.016, 95% CI 1.002-1.031,In this retrospective analysis, the odds of diagnosing AKA instead of TA ingestion increased as ethanol concentration increased. The limited ability of common clinical factors to differentiate these diagnoses highlights the need to obtain quantitative TA concentrations in real time. Until prospective validation, interpretation of ketone concentrations and toxic alcohol concentrations (when available) will continue to guide decision making.

Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before (P = 0.016) and after (P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.

Objective: Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ing...

Toxic alcohol poisoning can be lethal if not identified early and treated appropriately. Toxic alcohol assays are often unavailable in low-resource setting, so clinicians have to infer a diagnosis based on suspicion, repeated evaluation and biochemical course. We report a case of toxic alcohol poisoning concealed by auto-intoxication with in-hospital hand sanitizer. The eventual appearance of a concurrent high anion gap prompted dialysis. In another case, a comatose patient presented with a high osmolal gap and a high anion gap. Incorrect a priori opinions caused us to defer dialysis and the patient died shortly afterwards. Clinicians should be aware that toxic alcohol poisoning can produce a confusing diagnostic picture with an insidious course, and that doctor delay can prove fatal.LEARNING POINTS: Toxic alcohol ingestion may be lethal and warrants early identification, but this is not always possible.Incorrect a priori opinions by clinicians, or the co-ingestion of other alcohols by a patient, may produce a confusing diagnostic picture.Physicians should not defer immediate treatment for patients suspected of toxic alcohol ingestion with a double gap or visual disturbances.

Two male travelers with histories of gout and hazardous alcohol consumption, presented with a triad of severe culture-positive disseminated gonococcal infection, crystal-positive polyarticular gout, and gonococcal soft tissue collections, following unprotected sexual contact in The Philippines. Both men initially attributed symptoms to gout, since their usual joints were affected, but clinical deterioration occurred with self-administration of anti-inflammatory agents alone. The clinical courses were severe and protracted, requiring aggressive management of infection with prolonged intravenous antimicrobials and repeated surgery, and prolonged anti-inflammatory agents for gout. Joint symptom onset in each case occurred within a week of sexual exposure in conjunction with hazardous alcohol ingestion. We speculate that acute dissemination of infection to previously damaged joints triggered polyarticular gout, with progressive infection, exacerbated by unopposed anti-inflammatory agents and delayed antibiotics. Disseminated gonococcal infection can occur with polyarticular gout and delays in recognition and treatment, including while traveling, can lead to severe disease from both.

Background: Avascular necrosis (AVN) or osteonecrosis is the death of bone tissues due to decreased blood flow of femoral head, it is a major orthopaedic disease with many risk factors including the chronic alcohol and tobacco consumption. Aims and objectives: To study the relationship of alcohol and tobacco with AVN of femoral head in adult population. Materials and Methods: This study included 72 patients of AVN of femoral head (ONFH) who attending our hospital between Sept 2018 to Sept 2020. History of alcoholism and tobacco consumption, detailed information of the amount and duration of smoking and alcohol intake was recorded. Results: Majority of the AVN patients were working age groups males (72%) and 28% were females. Out of 72 patient 55% had history of alcohol consumption and 60% were smokers which indicates a positive correlation of cellular toxicity with AVN of femoral head. Conclusion: Present study conclude that the alcohol ingestion and tobacco smoking are the major cause of cellular toxicity and AVN of femoral heads. Keywords: alcohol drinking, femur head necrosis, smoking

Background This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only. Methods Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated. Results The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00–23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00–05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group. Conclusions Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.

Background Chronic pancreatitis is a progressive inflammation of the pancreas associated to fibrosis, pancreatic atrophy, calcifications, and chronic pain. Intractable pain is the main indication for surgical treatment. Surgical procedures are based in ductal decompression, ductal drainage, and resection. Aim Analyze the surgical management of patients with symptomatic calcified chronic pancreatitis. Methods From March 2009 and September 2019, 12 patients underwent surgical treatment due to chronic calcified pancreatitis. There were eleven male (91.7%) and one female (8.3%) and the mean age was 58.2 years (range 48–70 years). Regular alcohol ingestion was observed in all patients (100%). The main indication for surgery was pain control in ten patients (83.3%). Results The procedures included Partington-Rochelle (6 patients, 50.0%), Frey procedure (3 patients, 25.0 %), pancreatoduodenectomy (2 patients, 16.6%) and total pancreatectomy (1 patient, 8.3%). Four patients (33.3%) had postoperative complications. No Clavien-Dindo ≥ 3b complications and no 90-days mortality were recorded in this series. Postoperative exocrine dysfunction was observed in 4 patients (33.3%), and all of them received pancreatic enzyme supplement. Conclusions Surgical treatment is a safe and feasible choice with acceptable morbidity and no mortality for symptomatic patients with calcified chronic pancreatitis.

Acute beer or alcohol ingestion reduces arterial stiffness, but the dose required to reduce arterial stiffness is unclear. Therefore, this study aimed to determine the acute effects of ingesting various amounts of beer on arterial stiffness in healthy men. Nine men (20–22 years) participated, in eight trials in random order on different days. The participants each consumed 25, 50, 100, or 200 mL of alcohol-free beer (AFB25, AFB50, AFB100, and AFB200) or regular beer (B25, B50, B100, and B200), and were monitored for 60 min thereafter. Arterial stiffness did not significantly change among all AFB and B25. However, B50, B100, and B200 caused a significant decrease in arterial stiffness for approximately 30–60 min: heart-brachial pulse wave velocity (B50: −4.5 ± 2.4%; B100: −3.4 ± 1.3%; B200: −8.1 ± 2.6%); brachial-ankle pulse wave velocity (B50: −0.6 ± 2.0%; B100: −3.3 ± 1.1%; B200: −9.3 ± 3.0%); heart-ankle pulse wave velocity (B50: −3.7 ± 0.3%; B100: −3.3 ± 0.9%; B200: −8.1 ± 2.7%); and cardio-ankle vascular index (B50: −4.6 ± 1.3%; B100: −5.6 ± 0.8%; B200: −10.3 ± 3.1%). Positive control alcoholic beverages reduced arterial stiffness, and these reductions did not significantly differ regardless of the type of beverage. Our data show that consuming about 50 mL of beer can start to reduce arterial stiffness, and that the reduced arterial stiffness is mainly attributable to the alcohol in beer.

Background Alcohol consumption is associated with hyperuricemia and gout. Previous studies have indicated a role for green tea catechins in uric acid (UA) metabolism. This study aimed to elucidate the effect of green tea catechins in terms of enhancing urinary excretion of UA and xanthine/hypoxanthine (Xa/HX) after alcohol ingestion.Methods In a randomized crossover study, 10 healthy subjects consumed test meals, including a Japanese distilled spirit (Shōchū) with water (SW) or Shōchū with catechin-rich green tea (SC), each containing 20 g of alcohol. The SC contained 617 mg of total catechin. Serum and urine UA and Xa/HX concentrations were measured. Blood samples were collected after 2.5 h, and urine samples were collected between 0 and 5 h after consuming the test meal.Results Urine UA and Xa/HX excretions were significantly higher in the SC group than in the SW group ( P < 0.05). UA clearance and fractional UA excretion tended to increase more in the SC group than in the SW group. No significant differences in S-UA and S-Xa/Hx concentrations were observed between the SW and SC groups.Conclusions Based on these observations, it was concluded that green tea catechins can enhance the excretion of UA and Xa/HX, even though alcohol is ingested.Trial registration The protocol was approved by the Ethics Committee of the University of Shizuoka and registered with UMIN (University Hospital Medical Information Network in Japan). Trial registration number: UMIN000040076. Registered 7 April 2020 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045687

Bariatric surgery is an effective treatment for severe obesity in adolescence. Nevertheless, much remains to be understood regarding the impact of surgery on mental health, eating behaviors, and cognition. We review the findings related to mental health both before and after surgery as well as long-term changes in psychopathology, including suicide risk. Overall, adolescents with and without a history of psychopathology lose weight at similar rates. At the same time, there is an increased risk for suicide that requires further study. Regarding alcohol and substance use, this population reports lower rates of consumption than age related non-obese cohorts. Nevertheless the impact of altered anatomy and metabolism on alcohol ingestion in a population at risk for substance use is concerning. Eating behaviors, specifically loss of control eating, are discussed. Finally, we include discussion of the cognitive changes occurring perioperatively and considerations for adolescents with cognitive impairments. Clinical recommendations and suggestions for future research are discussed.

International audience; Recently, disulfiram has been proposed as a promising treatment for people suffering from persistent symptoms of Lyme Disease. Disulfiram has several distinct molecular targets. The most well-known is alcohol dehydrogenase, a key enzyme for detoxifying the organism after alcohol ingestion. Other targets and modes of action of disulfiram, that may present problematic side effects, are less commonly mentioned. The French Federation against Tick Borne Diseases (French acronym, FFMVT), which associates three main Lyme patient organizations, MDs and PhDs, has recently been alerted to severe and persistent toxic events in a patient suffering from a late disseminated form of Lyme Disease following disulfiram intake. FFMVT reacted by launching a national call to examine whether other patients in France following a similar treatment could be identified, and what benefits, or side effects could be reported. The statements of 16 patients taking disulfiram have been collected and are presented here. Thirteen out of 16 patients reported toxic events, and seven out of 16 reported benefits for at least part of their symptoms. Based on the collected observations, it seems too early to promote disulfiram as a promising new treatment until the reasons underlying the reported toxicities have been explored, and the results of a well-conducted double blind clinical trial published. The importance of taking into account patient-reported outcomes in Lyme Disease is underlined by the present study.

Rationale Car-driving performance is negatively affected by the intake of alcohol, tranquillizers, sedatives and sleep deprivation. Although several studies have shown that the standard deviation of the lateral position on the road (SDLP) is sensitive to drug-induced changes in simulated and real driving performance tests, this parameter alone might not fully assess and quantify deviant or unsafe driving. Objective Using machine learning we investigated if including multiple simulator-derived parameters, rather than the SDLP alone would provide a more accurate assessment of the effect of substances affecting driving performance. We specifically analysed the effects of alcohol and alprazolam. Methods The data used in the present study were collected during a previous study on driving effects of alcohol and alprazolam in 24 healthy subjects (12 M, 12 F, mean age 26 years, range 20–43 years). Various driving features, such as speed and steering variations, were quantified and the influence of administration of alcohol or alprazolam was assessed to assist in designing a predictive model for abnormal driving behaviour. Results Adding additional features besides the SDLP increased the model performance for prediction of drug-induced abnormal driving behaviour (from an accuracy of 65 %–83 % after alprazolam intake and from 50 % to 76 % after alcohol ingestion). Driving behaviour influenced by alcohol and alprazolam was characterised by different feature importance, indicating that the two interventions influenced driving behaviour in a different way. Conclusion Machine learning using multiple driving features in addition to the state-of-the-art SDLP improves the assessment of drug-induced abnormal driving behaviour. The created models may facilitate quantitative description of abnormal driving behaviour in the development and application of psychopharmacological medicines. Our models require further validation using similar and unknown interventions.

This chapter provides a review of toxic alcohol poisonings. We will discuss the biochemistry of these poisonings as it relates to diagnosis and management. In addition, we will compare and contrast the toxicities caused by ingestion of ethylene glycol, methanol, and isopropyl alcohol.

Background While it is well established that Roux-en-Y gastric bypass (RYGB) causes a rapid and heightened peak blood alcohol concentration (BAC), results from previous studies on the effects of sleeve gastrectomy (SG) on alcohol pharmacokinetics are conflicting. Data from 2 studies found SG did not affect BAC, whereas another study found SG caused a heightened peak BAC after alcohol ingestion. Moreover, these 3 studies estimated BAC from breathalyzers, which might not reliably estimate peak BAC. Objectives The aims of this study were to evaluate (1) the effect of SG, relative to RYGB and a presurgery group, on alcohol pharmacokinetics and subjective effects, and (2) whether breathalyzers are reliable in this population. Setting Single-center prospective nonrandomized trial. Methods We performed alcohol challenge tests in 11 women who had SG surgery 1.9 ± .1 years ago (body mass index = 35.1 ± 6.6 kg/m2), 8 women who had RYGB surgery 2.2 ± .4 years ago (body mass index = 30.0 ± 5.2 kg/m2), and 9 women who were scheduled for bariatric surgery (body mass index = 44.1 ± 4.0 kg/m2). BACs were estimated from breath samples and measured by gas chromatography at various times after consuming approximately 2 standard drinks. Results BAC increased faster, peak BAC was approximately 2-fold higher, and feelings of drunkenness were heightened in both SG and RYGB groups relative to the presurgery group (P values Conclusions SG, similar to RYGB, causes marked alterations in the response to alcohol ingestion manifested by a faster and higher peak BAC. The breathalyzer is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol.

Dear Editor,We applaud Cohen et al. [1] for attempting to answer the question of how to distinguish toxic alcohol ingestion from alcoholic ketoacidosis (AKA). The short answer is that we cannot – a...

Background: The aim of this study was to propose a new stochastic model to study the time course of ethanol elimination in human bodies.Methods: The times and amount of alcohol ingested are assumed to be random in controllable intervals. Constant elimination rate follows zero order kinetics and is replaced by first order kinetics when the effects of alcohol increase due to alcohol ingestion. Simulation studies of three different models were made to compare the statistical characteristics of the ethanol effects obtained using analytical expressions. For each model, three cases were considered depending on the drinking pattern and by classifying the drinker as heavy, normal or sparse.Results: From the model formulation, we noted that as the rate of drinking increases for a given elimination rate, the expected time between overflows goes towards zero. Furthermore, as the average amount of alcohol in each drink increases, the corresponding time between overflows decreases.Conclusion: Variations in times of alcohol intakes as well as the amount of alcohol consumption can be accounted through the final created formula. The model proves that overflows occur when alcohol is ingested before the adverse effects of alcohol from the previous drink are completely eliminated. Being the first stochastic model of such a kind, we do hope that it will throw more light on interpreting experimental data of alcohol abuse. Keywords: Alcohol ingestion, Elimination rate, Overflow, Multiple doses, Zero order kinetics, First order kinetics

Alcohol consumption seems to affect corpus callosum morphometry irrespectively of an alcohol use disorder (AUD) diagnosis. The present study examined the relationship between corpus callosum (CC) subregion volumes and alcohol use patterns in AUD and non-AUD subjects. Twenty-two male AUD patients and 23 healthy matched non-AUD subjects were recruited from March 2016 to July 2017. Volumetric data were acquired through Magnetic Resonance and analyzed by the FreeSurfer software. AUD subjects were in abstinence for 45.1 days ± 36.8 (SD), consumed higher amounts of alcohol and presented higher AUDIT scores than controls (p < 0.0001). A multivariate analysis corrected by age and tobacco use indicated that AUD patients presented smaller CC volumes compared to non-AUD subjects (p < 0.01), except for the posterior subregion. A multiple regression analysis corrected by age and tobacco use including CC volumes from all subjects and the amount of daily alcohol ingestion as variables indicated that anterior CC volume was negatively (p < 0.001) associated to alcohol consumption. This study demonstrated that CC subregions were smaller in AUD subjects, as expected, and that the volume of the anterior segment was inversely associated to increasing daily amounts of alcohol, indicating greater frontal region vulnerability to harmful alcohol effects.

Introduction Methanol poisoning is an uncommon life-threatening ingestion associated with significant morbidity and requires prompt diagnosis and management for the best possible outcome. We created a simulation case that challenges learners to analyze case information, construct a differential diagnosis of an anion gap metabolic acidosis, narrow the differential based on reasoning, and empirically initiate management. Methods The simulation case was designed for emergency medicine residents and pediatric emergency medicine fellows. The activity began with a brief overview of the monitors, equipment, and simulation experience. First-year residents managed the case as a team of two. Second- and third-year residents and fellows managed the case alone. The learners had 15 minutes to complete a focused history and physical exam, request and interpret labs and studies, provide stabilization of life threats, and initiate specific interventions based on a presumptive diagnosis. The simulation was followed by a 20-minute facilitated debrief session that reviewed key learning points and learner performance based on an evaluation checklist. Results Residents completed a six-question, 5-point Likert-scale postparticipation questionnaire. Overall, residents reported a high degree of satisfaction with the simulation experience. The case and debrief were effective in meeting the educational objectives and proved to be an effective modality to fill this educational gap. Discussion This simulation experience successfully exposed residents to the uncommon presentation of methanol poisoning. The simulation experience effectively closed the identified educational gap and provided an experiential learning opportunity that accomplished the targeted learning objectives.

In the intersection of alcohol ingestion with the law, medical ethics, and public safety, physicians are often unsure about how to proceed. Physicians' primary focus should be on patient education with an ethical and legal duty to warn the patient of the adverse effects of alcohol. Warning third parties of potential harm related to alcohol-related impairment may involve a breach of patient confidentiality; therefore it should only be undertaken after careful analysis suggests that the risk for significant harm exceeds the burden that results to the patient from warning others. The law remains vague in this area.

We thank Mullins et al. [1] for their comments and provide the following responses. The goal of any retrospective analysis is to inform questions for prospective study. While we had hypothesized th...

Our aim was to analyze the association between different social contexts of physical activity (PA) and depressive symptoms. Data from the Brazilian National Health Survey (PNS) (n = 59,722; ≥18 years) were used. The social context of leisure-time PA [classified according to the higher probability of being practiced in group (group PA) or individually (individual PA)] and total PA time were self-reported. Depressive symptoms were evaluated through the Patient Health Questionnaire-9. Chronological age, ethnicity, educational status, employment status, tobacco smoking, alcohol ingestion, and soft drink consumption were co-variables. Logistic regression models were applied for association analyses. Among men, individual and group PA were associated with lower depressive symptoms compared with the no PA group among men [Individual: OR:0.59 (95%CI:0.40 to 0.86); Group: OR:0.42 (95%CI:0.29 to 0.59)]. Sensitivity analysis revealed that men involved in group PA were 40% [OR:0.60 (95%CI:0.38 to 0.94)] less likely to present elevated depressive symptoms when compared with individual PA. In females, no differences in depressive symptoms were observed comparing individual PA [OR:0.89 (95%CI:0.71 to 1.11)] and group PA [OR:0.86 (95%CI:0.54 to 1.37)] with the no PA group. Activities that are more likely to be a group PA demonstrated a stronger association with low depressive symptoms among men, but not women.

A healthy 25 year old woman presented with acute urinary retention following alcohol ingestion. A 14 french foley catheter drained over 1 L of haematuria immediately. Due to worsening and persistent abdominal pain, CT and ultrasound imaging was performed, demonstrating only a small amount of free fluid. Diagnostic laparoscopy revealed an intraperitoneal bladder perforation with the foley catheter visible. The bladder defect was repaired and she recovered well. This is a rare case of likely iatrogenic bladder perforation from simple catheterisation without predisposing comorbidities, highlighting the importance of correct technique and awareness of potential complications.

A 54-year-old woman with a known history of excessive alcohol ingestion (20 g/day) and depression was admitted at the emergency room with epigastric pain, haematemesis and melena. At physical examination, she was found severally ill, with cold extremities and a distended abdomen. Hypotension (80/

Background: Acute pancreatitis is a process of acute inflammation of the pancreas usually caused by biliary stones, alcohol ingestion, metabolic factors or drugs. The assessment of the severity of acute pancreatitis has a significant role in its management. There is a need for a simple and clinically oriented severity scoring system that can predict severity of acute pancreatitis at the time of presentation. Methods: A cross-sectional study was conducted at a tertiary care centre on 100 patients diagnosed as acute pancreatitis who fulfilled the inclusion criteria. Severity index, their BISAP Score, BMI and CRP values were calculated and statistical analysis was done using SPSS 17 Software. Results: In our study, there were 100 patients with pancreatitis. 65% were alcoholic pancreatitis followed by gall stone pancreatitis (17%), idiopathic pancreatitis (13%), drug induced (1%), trauma (1%), post ERCP (1%) and malignancy (2%). On the basis of CT Severity index, it was found that 15% of alcoholic group, 8% of biliary group and 1% each of idiopathic, drug induced, trauma and malignancy group were found to have severe pancreatitis. On the basis of BISAP Score it was found that 17% in alcoholic group, 7% in gall stone group, 4% in idiopathic group, 2% in malignancy group and 1% each in drug induced and trauma group were having acute pancreatitis. With the C reactive Protein level, it was found that 16% in alcoholic group, 9% in biliary group and 1% each in idiopathic, trauma and malignancy group were found to have severe pancreatitis. The sensitivity and specificity for BISAP score were 77.8% and 84.9% and the sensitivity and specificity for CRP were 66.7% and 86.3%. The K-score was found to be 0.593 for BISAP Score and 0.524 for C - reactive protein levels. This indicates that both are in moderate agreement with the gold standard test (CT Severity Index). Conclusions: BISAP score and CRP levels are not superior to the each other in predicting severity. BISAP score can be used as a predictor of severity at admission and CRP levels ≥150 can predict severity when serially monitored during the course of admission.

Positional alcohol nystagmus (PAN) is characterized by positional direction-changing nystagmus. Although the buoyancy cupulopathy, which implies that the cupula becomes lighter or heavier than the endolymph due to different diffusion rates of alcohol, has been accepted as possible mechanism of PAN, the evidence supporting this hypothesis is weak. The aim of present study is to investigate the possibility of serum osmolality change following alcohol intake as a cause of PAN. Nine healthy adults were recruited voluntarily. Positional nystagmus was examined before and every 1 hr after alcohol intake until 7 hr. Serum osmolality was measured before and 1 and 7 hr after alcohol intake. Before ingesting alcohol, no subject showed positional nystagmus, and mean serum osmolality was 285.9 ± 4.4 mOsm/kg. At 1 hr after drinking, mean serum osmolality increased to 302.9 ± 8.9 mOsm/kg, and all subjects exhibited geotropic positional nystagmus. At 7 hr after drinking, mean serum osmolality decreased to 289.1 ± 9.4 mOsm/kg, and all subjects showed ageotropic positional nystagmus. Change in serum osmolality following alcohol ingestion and subsequent change in specific gravity in the perilymph and endolymph may be a cause of PAN.