Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12500 patients were admitted to hospital with a history of drinking illegal cheap "vodka" in 44 different regions in Russia, of whom 9.4% died. In reality, the "vodka" was an antiseptic liquid composed of ethanol (˜93%), diethyl phthalate, and 0.1-0.14% PHMG (brand name "Extrasept-1").
We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included.
The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean ± SD): total bilirubin 249 ± 158 µmol/L, direct bilirubin 166 ± 97 µmol/L, cholesterol 14 ± 8 mmol/L, alanine aminotransferase 207 ± 174 IU/L, aspartate aminotransferase 174 ± 230 IU/L, alkaline phosphatase 742 ± 751 IU/L, and gamma-glutamyltranspeptidase 1199 ± 1095 IU/L. Patients generally recovered over a period of 1-5 months, although high levels of alkaline phosphatase and gamma-glutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, inflammatory infiltration, and fibrosis developing into cirrhosis were found by liver biopsy.
Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe inflammatory component causing high mortality.
OBJECTIVES. The changing pattern of acute poisoning may affect complications and outcome in these patients. An update study on acute poisonings was therefore performed and compared to similar data from 1980. DESIGN. A prospective cross-sectional multi-center study of all adult patients (> or = 16 years) hospitalized in Oslo with a main diagnosis of acute poisoning, irrespective of intention, over a one-year period. RESULTS. Of 947 admissions, 222 (23%) were comatose. Complications were observed in 173 (18%), slightly reduced from 1980 (22%). Ten (1.1%) died and six (0.6%) got permanent sequelae, of which seven and five were drug- or alcohol-related, respectively. Seventy-five percent received treatment besides observation; 39% received antidotes, increased from 21% in 1980, most frequently flumazenil (23%) and naloxone (14%). CONCLUSIONS. In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.
OBJECTIVES. Prospective design is mandatory to study pattern of poisoning and suicidal intention of patients. MATERIAL AND METHODS. Prospective cross-sectional multi-center study of all patients contacting health care services because of acute poisoning during one year in Oslo, irrespective of intention. Data on the adult hospitalized patients (> or = 16 years) are presented here. RESULTS. Of a total of 3,775 such adult contacts (3,025 episodes), there were 947 (31 %) hospitalizations; annual incidence 1.9 (per 1,000) in males and 2.1 in females. Median age was 36 years (range 16-89); 54% females. Benzodiazepines (18%), ethanol (17%), paracetamol (12%), opioids (7%), and gamma hydroxybutyric acid (GHB) (7%) were most frequently taken. Patients stated suicidal intention in 29% of the admissions; physicians in 10%. CONCLUSION. Benzodiazepines and ethanol were the most common agents, but newer illicit drugs were frequent, especially GHB. Males often took ethanol and drugs of abuse; females often used prescription drugs with suicidal intention.
To investigate longitudinally for both genders the relation between the age of onset of drinking and several indicators of alcohol use.
In the Finnish Jyväskylä Longitudinal Study of Personality and Social Development, data have been collected by interviews, inventories, and questionnaires. Data on alcohol consumption was gathered at ages 14, 20, 27, 36 and 42 years; behavioural data at age 8.
A total of 155 women and 176 men; 90.4% of the original sample consisting of 12 complete school classes in 1968.
The age of onset of drinking was determined based on participants' responses that were closest to the actual age of onset of drinking. Four indicators of the adult use of alcohol were used: frequency of drinking, binge drinking, Cut-down, Annoyed, Guilt, Eye-opener (CAGE) and Malmö modified Michigan Alcoholism Screening Test (Mm-MAST). Socio-emotional behaviour at age 8 was assessed using teacher ratings and peer nominations.
Early onset of drinking was related to the four indicators of the use of alcohol in adulthood both in men and women. The level of adult alcohol use and alcohol problems was significantly higher in men. The risk for heavy drinking was highest in men and women if drinking was started at less than age 16 years. Socio-emotional behaviour and school success at age 8 did not predict the age of onset of drinking.
Delaying the initiation of drinking from early adolescence to late adolescence is an important goal for prevention efforts. No clear risk group for early initiators of drinking could be identified on the basis of preceding behaviour among 8-year-olds.
Comment In: Evid Based Ment Health. 2005 Nov;8(4):9816246874
To discuss the hypothesis that alcohol, and binge drinking in particular, is a major determinant of the recent mortality fluctuations in Russia.
Discussion based on published literature.
The hypothesis is based on circumstantial evidence. The changes in mortality coincided with introduction and collapse of the Soviet anti-alcohol campaign. The largest relative changes in mortality were observed for "alcohol-related causes" (a specific diagnostic category used in Russia) as well as violent and accidental deaths, but the largest absolute changes were observed for cardiovascular causes which had the largest impact on all-cause mortality. There is no direct support for the hypothesis. Available estimates of alcohol consumption in Russia are low, and the only published study on alcohol and mortality conducted in Russia produced negative results. Increase in drinking prevalence alone would not explain the mortality rise; increase in relative risk related to alcohol would also be needed. The biological mechanisms which could underlie the presumed strong effects of alcohol on heart disease are not clear. On the other hand, binge drinking has not been addressed adequately by research so far.
Until a well designed study is conducted in Russia, the hypothesis remains debatable.
Comment In: Ann Epidemiol. 1999 Aug;9(6):339-4010475532
Comment In: Ann Epidemiol. 2001 Jan;11(1):1-611164113
Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007, male life expectancy at birth was 61 years, while for females it was 74 years. Alcohol is implicated particularly in deaths among working-age men.
To review the current state of knowledge about the contribution of alcohol to the continuing very high mortality seen among Russian adults
Conservative estimates attribute 31-43% of deaths among working-age men to alcohol. This latter estimate would imply a minimum of 170 000 excess deaths due to hazardous alcohol consumption in Russia per year. Men drink appreciably more than women in Russia. Hazardous drinking is most prevalent among people with low levels of education and those who are economically disadvantaged, partly because some of the available sources of ethanol are very cheap and easy to obtain. The best estimates available suggest that per capita consumption among adults is 15-18 litres of pure ethanol per year. However, reliable estimation of the total volume of alcohol consumed per capita in Russia is very difficult because of the diversity of sources of ethanol that are available, for many of which data do not exist. These include both illegal spirits, as well as legal non-beverage alcohols (such as medicinal tinctures). In 2006 regulations were introduced aimed at reducing the production and sale of non-beverage alcohols that are commonly drunk. These appear to have been only partially successful.
There is convincing evidence that alcohol plays an important role in explaining high mortality in Russia, in particular among working age men. However, there remain important uncertainties about the precise scale of the problem and about the health effects of the distinctive pattern of alcohol consumption that is prevalent in Russia today. While there is a need for further research, enough is known to justify the development of a comprehensive inter-sectoral alcohol control strategy. The recent fall in life expectancy in Russia should give a renewed urgency to attempts to move the policy agenda forward.
Previous research suggests that a strong relation exists between alcohol consumption and suicide in Soviet and post-Soviet Russia. This study extends this analysis across a much longer historical time frame by examining the relationship between heavy drinking and suicide in tsarist and post-World War II Russia.
Using alcohol poisoning mortality data as a proxy for heavy drinking, time-series analytical modeling techniques were used to examine the strength of the alcohol-suicide relation in the provinces of European Russia in the period 1870-1894 and for Russia in 1956-2005.
During 1870-1894, a decreasing trend was recorded in heavy drinking in Russia that contrasted with the sharp increase observed in this phenomenon in the post-World War II period. A rising trend in suicide was recorded in both study periods, although the increase was much greater in the latter period. The strength of the heavy drinking-suicide relation nevertheless remained unchanged across time, with a 10% increase in heavy drinking resulting in a 3.5% increase in suicide in tsarist Russia and a 3.8% increase in post-World War II Russia.
Despite the innumerable societal changes that have occurred in Russia across the two study periods and the growth in the level of heavy drinking, the strength of the heavy drinking-suicide relation has remained unchanged across time. This suggests the continuation of a highly detrimental drinking culture where the heavy episodic drinking of distilled spirits (vodka) is an essential element in the alcohol-suicide association.
Moderate alcohol consumption has been shown to protect against cardiovascular diseases. The association between alcohol consumption, especially types of alcoholic beverages, and venous thromboembolism (VTE) is less well described. The aim of this study was to investigate the impact of alcohol consumption and different alcoholic beverages on risk of VTE. Information on alcohol consumption was collected by a self-administrated questionnaire in 26,662 subjects, aged 25-97 years, who participated in the Tromsø Study, in 1994-1995. Subjects were followed through September 1, 2007 with incident VTE as the primary outcome. There were 460 incident VTE-events during a median of 12.5 years of follow-up. Total alcohol consumption was not associated with risk of incident VTE. However, subjects consuming = 3 units of liquor per week had 53% increased risk of VTE compared to teetotalers in analyses adjusted for age, sex, body mass index, smoking, diabetes, cancer, previous cardiovascular disease, physical activity and higher education (HR: 1.53, 95% CI: 1.00-2.33). Contrary, subjects with a wine intake of = 3 units/week had 22% reduced risk of VTE (HR: 0.78, 95% CI: 0.47-1.30), further adjustment for liquor and beer intake strengthened the protective effect of wine (HR: 0.53, 95% CI: 0.30-1.00). Frequent binge drinkers (= 1/week) had a 17% increased risk of VTE compared to teetotallers (HR 1.17, 95% CI: 0.66-2.09), and a 47% increased risk compared to non-binge drinkers (HR 1.47, 95% CI: 0.85-2.54). In conclusion, liquor consumption and binge drinking was associated with increased risk of VTE, whereas wine consumption was possibly associated with reduced risk of VTE.
Peptic ulcer disease is a common clinical problem. Binge drinking has been shown to increase the risk of ulcer at the individual level.
To estimate the aggregate level effect of binge drinking on duodenum ulcer mortality rate.
Trends in age-adjusted, sex-specific fatal alcohol poisoning and duodenum ulcer mortality rates in Russia from 1965 to 2005 were analyzed employing an ARIMA analysis in order to asses a bivariate relationship between the two time series.
Time series analysis indicate the presence of statistically significant association between the two series for male (r = 0.51; SE = 0.16). The association between the two time series for female is also positive, however, statistically not significant (r = 0.25; SE = 0.14).
This paper present new epidemiological evidence of aggregate level relationship between alcohol and duodenum ulcer mortality rate. The outcome of this study also supports the hypothesis that binge drinking of strong spirits is a risk factor of ulcer at the individual level.