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Alcohol‐related liver disease (ALD) is the leading indication for liver transplantation worldwide. Since Mathurin et al. described their experience in providing early liver transplantation for patients with ALD in 2011, other centers have followed suit with generally favorable survival outcomes. This patient population poses a unique clinical challenge given the expedited nature of the evaluation and the lack of any significant sobriety period prior to transplantation. The SALT (Sustained Alcohol Use Post‐Liver Transplant) score is a standardized psychometric tool increasingly used to help stratify the risk of relapse and guide listing decisions for these challenging clinical situations. In 2018, our center introduced a protocol for early liver transplantation for acute alcohol‐related hepatitis (AAH). In this article, we offer a retrospective review of 26 patients transplanted between May 2018 and May 2021, including at least 1‐year follow‐up, and compare outcomes to initial SALT scores; we further identify additional factors that may impact post‐transplant success. As transplant committees continue to weigh the ethical dilemma of denying lifesaving treatment against the obligation to remain stewards of a limited resource, we aim to contribute to a more nuanced understanding of risk regarding early transplantation for ALD. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 25-year-old woman with a history of acute intermittent porphyria who was admitted to the hospital due to abdominal pain and jerking movements of the right arm and leg.Topics discussed include the patient's symptoms, including abdominal pain, nausea, confusion, agitation, and a painful rash, previous experiences with acute intermittent porphyria and the management of her symptoms, including the administration of medications.

Objective: To estimate the association between COVID-19 and Emergency Department (ED) psychiatric presentations, including suicidal ideation. Methods: Using an interrupted time series design, we analyzed psychiatric presentations using electronic health record data in an academic medical center ED between 2018 and 2020. We used regression models to assess the association between the onset of the COVID-19 outbreak and certain psychiatric presentations. The period February 26–March 6, 2020 was used to define patterns in psychiatric presentations before and after the coronavirus outbreak. Results: We found a 36.2% decrease (unadjusted) in ED psychiatric consults following the coronavirus outbreak, as compared to the previous year. After accounting for underlying trends, our results estimate significant differential change associated with suicidal ideation and substance use disorder (SUD) presentations following the outbreak. Specifically, we noted a significant differential increase in presentations with suicidal ideation six weeks after the outbreak (36.4 percentage points change; 95% CI: 5.3, 67.6). For presentations with SUD, we found a differential increase in the COVID-19 time series relative to the comparison time series at all post-outbreak time points and this differential increase was significant three weeks (32.8 percentage points; 95% CI: 4.0, 61.6) following the outbreak. Our results estimate no differential changes significant at the P value < 0.05 level associated with affective disorder or psychotic disorder presentations in the COVID-19 time series relative to the comparator time series. Conclusions: The COVID-19 outbreak in Boston was associated with significant differential increases in ED presentations with suicidal ideation and SUD. [ABSTRACT FROM AUTHOR]

The article presents a case study of 27-year-old woman with opioid use disorder and suicidal ideation. It notes history of polysubstance use disorder, cutting behavior during adolescence, and anxiety and depression; and mentions management of acute pain and the longitudinal treatment of opioid use disorder.

The article presents a case study of a 54 year old man evaluated for acute altered mental status after being hospitalized for alcohol withdrawal. Topics discussed the patient enrolled in an addiction treatment program in a residential clinical stabilization service; mentions the symptoms of patient like headache, nausea, nonbloody and nonbilious emesis; and information on the acute decline in mental status and numerous metabolic disturbances.