Alcoholism: the disease and the diagnosis
Article Abstract:
A recent study showed that alcohol abuse and dependence is frequently underdiagnosed. Alcohol abuse and dependence are often associated with other illnesses, including gastrointestinal disease, trauma, and dementia. Alcohol abuse is an abnormal pattern of alcohol use that persists despite adverse social, work-related, psychological, and physical consequences. Alcohol dependency, or alcoholism, is a primary chronic disease caused by genetic, psychosocial, and environmental factors, and is characterized by inability to control drinking, obsession with alcohol, continued alcohol use despite its adverse effects, and impaired thinking such as denial of the problem. Alcohol abuse and dependency affects 15 to 60 percent of hospitalized patients, results in enormous medical costs, and can cause psychiatric problems in family members and friends. A recent survey showed that alcohol abuse was recognized by physicians in only one third of hospitalized patients who tested positive for alcoholism using two established screening tests. A physician may not record a diagnosis of alcohol abuse for a patient to avoid the patient's anger or shame, because of the physician's own ambivalence, or to avoid insurance problems. Some physicians may think they are protecting a patient from discomfort by not dealing with the problem. Society's prejudice against the alcoholic is another factor. Physicians may also be uncertain about the diagnosis. Other physicians deny that a problem exists because they are alcoholic themselves. Alcohol abuse is reported more often for Medicaid recipients and persons with low income. Patients with inflammation of the pancreas, injuries, illegal drug use, liver disease, and dementia should be evaluated for alcohol abuse. Alcohol abuse can be detected by careful interviewing and screening tests. Physicians should also look for abnormal laboratory findings consistent with alcohol toxicity, defensive behavior in a patient, and a family history of alcoholism. Chemical dependence counseling can be recommended, along with the assurance of continued professional support for the patient from the physician. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Confirmed rabies exposure during pregnancy: treatment with human rabies immune globulin and human diploid cell vaccine
Article Abstract:
A case report is presented of a 27-year-old pregnant woman who was bitten by a bat she had coaxed into a cage and fed. This is the 25th case reported in the medical literature of rabies virus exposure during pregnancy. The patient's small wound on the left index finger was carefully cleaned and prophylactic treatment against rabies was started. The patient was 14 weeks pregnant. She received human rabies immune globulin (RIG) and human diploid cell vaccine (HDCV), agents whose effectiveness in pregnant women has not been thoroughly investigated because of the rare occurrence of human rabies in the US. The patient was given RIG and HDVC when first treated in the emergency room, and then received HDCV on day 3, 7, 14, and 28 after the bite. The bat tested positive for rabies virus. A male infant was developed after 40 weeks' gestation; he was cyanotic (bluish in color from lack of oxygen) and needed surgery to correct a congenital defect of the blood vessels. This surgery was successful and the infant has an excellent prognosis. The mother developed no symptoms of rabies. Other pregnant patients exposed to rabies have been vaccinated with equine rabies globulin; two infants were premature and one miscarriage occurred; other infants had no apparent physical or mental abnormalities. In this case, RIG and HDVC appeared safe and effective during pregnancy. Because death is likely if a bite from a rabid animal is untreated, prompt treatment of pregnant women bitten by such animals is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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