Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward

Objectives Disulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department. Methods Clinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction. Results Seventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction. Discussion and conclusions A disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.

Uji Aktivitas Ekstrak Etanol Daun Lidah Buaya (Aloe Vera) Terhadap Penghambatan Pertumbuhan Staphylococcus aureus Dan Candida albicans

This study aims to determine the activity of ethanol extract of Aloe vera leaves against Staphylococcus aureus bacteria and Candida albicans fungi. Extraction of aloe vera leaves is done by maceration method, then extracted several concentrations, namely 2.5%, 3.5%, and 4.5% for Staphylococcus aureus bacteria and concentrations of 4%, 8% and 12% for Candida albicans fungi. The inhibitory testing is done by agar diffusion method. The test results showed that the ethanol extract of Aloe vera leaves had antibacterial activity of Staphylococcus aureus and anti-fungal Candida albicans which was characterized by the presence of a clear zone. In Staphylococcus aureus bacteria provide optimum inhibition zone at a concentration of 4.5% with a diameter of 10.8 mm while in, the fungus Candida albicans provides the optimum inhibition zone at a concentration of 12% with a diameter of resistance 18.87 mm. Key Words: Ethanol, Aloe vera leaves, Staphylococcus aureus, Candida albicans