Clinical management of alcohol use disorders in the neurology clinic

Intranasal erythropoietin ameliorates neurological function impairments and neural pathology in mice with chronic alcoholism by regulating autophagy‑related Nrf2 degradation

The neurological disorders and neural pathology brought about by chronic alcoholism are difficult to be reversed. Increasing evidence highlights the protective roles of erythropoietin (EPO) in neurodegenerative diseases and injuries of the central nervous system. In the present study, we investigated the therapeutic effects of EPO on the neurological function deficits and neural pathology caused by chronic alcoholism and the regulatory mechanisms. Using the canonical mouse model of chronic alcohol exposure designed to mimic the repeated cycles of heavy abuse typical of chronic alcoholism, it was found that EPO delivered via intranasal route effectively restored the alcohol-impaired motor cooperation in rotarod and beam walk tests, reversed alcoholic cognitive and emotional alterations in the novel location recognition task and open-filed test, and rescued alcohol-disrupted nervous conduction in the somatosensory-evoked potential (SSEP) test. Consistently, the intranasally administered EPO promoted the remyelination and synapse formation in chronic alcohol-affected neocortex and hippocampus as evidenced by immunofluorescence staining and transmission electron microscopy. Additionally, we discovered that the exogenous rhEPO, which entered the cerebrum through intranasal route, activated the erythropoietin receptor (EPOR) and the downstream ERKs and PI3K/AKT signaling, and suppressed autophagy-related degradation of nuclear factor, erythroid 2-like 2 (Nrf2). Furthermore, the intranasal EPO-exerted neuroprotection was almost abolished when the specific Nrf2 antagonist ATRA was administered intraperitoneally prior to intranasal EPO treatment. Collectively, our data demonstrated the repairing potential of EPO for the neurological disorders and neural pathology caused by chronic alcoholism, and identified the Nrf2 activity as the key mechanism mediating the protective effects of EPO.

Screening, Diagnosis, and Management of Patients With Alcohol Use Disorders at Bwindi Community Hospital, Uganda

Introduction: The harmful use of alcohol is a growing global public health concern, with Sub-Saharan Africa at particular risk. A large proportion of adults in Uganda consume alcohol and the country has a high prevalence of alcohol use disorders (AUD), almost double that for the African region as a whole. Bwindi Community Hospital, in rural western Uganda, recently introduced a program of screening, diagnosis and management of AUD and we assessed how this worked.

Methods: This was a cross-sectional study in three departments (out-patients, adult in-patients and sexual & reproductive health) of Bwindi Community Hospital assessing numbers of patients screened, diagnosed and treated with AUD between January 2014 and June 2017. Data sources included the hospital electronic data base and departmental case files. Frequencies and proportions are reported and odds ratios used to compare specific factors associated with medical interventions.

Results: Altogether, 82,819 patients attended or were admitted to hospital, of whom 8,627 (10.4%) were screened and 273 (3.2%) diagnosed with AUD. The adult in-patient department recorded the largest number with AUD (n = 206) as well as a consistent increase in numbers in the last 18 months of the study. Of those with AUD, there were 230 (84%) males, 130 (48%) aged 36–60 years, and 131 (48%) with medical non-alcohol related diagnostic categories. Medical/supportive interventions included guidance and counselling to 168 (62%), community social support to 90 (33%), mental health service referrals for 75 (27%), detoxification for 60 (22%) and referral to Alcoholics Anonymous for 41 (15%). There were 36 (15%) patients who received no medical/supportive interventions, with significantly higher proportions in patients with surgical alcohol-related disease and pregnancy-related conditions (P < 0.05).

Conclusion: Bwindi Community Hospital has implemented a program for AUD in three departments, with most individuals screened and managed in the adult in-patient department. While a variety of interventions were given to those with AUD, 15% received no intervention and this deficiency must be addressed. Program performance could improve through better screening processes, ensuring that 100% of those with AUD receive a medical/supportive intervention and raising public awareness.