scholarly journals Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

2017 ◽  
Vol 30 (7-8) ◽  
pp. 517
Author(s):  
Rodrigo Andrade ◽  
Manuel Gonçalves-Pinho ◽  
António Roma-Torres ◽  
Isabel Brandão
Keyword(s):  
Anorexia Nervosa ◽  
Dropout Rate ◽  
University Hospital ◽  
High Rate ◽  
Prognostic Features ◽  
Illness Duration ◽  
Intense Fear ◽  
Life Threatening ◽  
Fear Of Weight Gain ◽  
The Impact

Introduction: Anorexia nervosa is a severe, usually chronic, life-threatening disease of complex etiology characterized by food restriction, overestimation of the importance of body weight and image, intense fear of weight gain and distortion of body image. Anorexia nervosa is associated with high rates of mortality, suicide and decreased quality of life. Our aim is to present an anorexia nervosa treatment program offered in a major university hospital in Portugal, and to determine the impact of illness duration before admission on the outcome. Our hypothesis is that patients with greater disease longevity may have worse prognosis and poorer outcome.Material and Methods: The sample included data from case records of 169 patients seen consecutively and for the first time at Centro Hospitalar São João, between 2010 and 2015. We performed a retrospective observational study which included data collected at admission and from later follow-up years.Results: From the initially selected patients, 14.8% reached total remission, 16% accomplished partial remission and 14.2% ended up with exacerbation/stagnation of the disease. The dropout rate was of 55% throughout our study period. We found significant differences on outcome rates between distinct illness duration groups (p = 0.007).Discussion: There are several factors frequently associated with poor outcome for anorexia nervosa. The interpretation of outcome findings was limited by the high rate of dropout and lack of consistent definition criteria.Conclusion: Our results support the idea that illness duration has an important role on the outcome and prognostic features of these patients.

scholarly journals Discharge Body Mass Index, Not Illness Chronicity, Predicts 6-Month Weight Outcome in Patients Hospitalized With Anorexia Nervosa

2021 ◽  
Vol 12 ◽  
Author(s):  
Graham W. Redgrave ◽  
Colleen C. Schreyer ◽  
Janelle W. Coughlin ◽  
Laura K. Fischer ◽  
Allisyn Pletch ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anorexia Nervosa ◽  
Body Mass ◽  
Adult Women ◽  
Short Term ◽  
Illness Duration ◽  
Weight Restoration ◽  
The Impact

Proposed treatments for severe and enduring anorexia nervosa (SE-AN) focus on quality of life, and psychological and social functioning. By de-emphasizing weight restoration as a priority, however, premature diagnosis of SE-AN may reduce potential for recovery. The present study assessed the effect of weight restoration, illness duration, and severity on treatment outcome 6 months after discharge from an intensive, meal-based behavioral treatment program. Participants included hospitalized adult women (N = 191) with AN or underweight other specified feeding and eating disorder (OSFED). Participants were characterized as short-term (ill <7 years; n = 74) or long-term ill (ill ≥ 7 years; n = 117). Compared with short-term ill, long-term ill patients were older, had lower lifetime body mass index (BMI), more prior admissions, and exhibited greater depression and neuroticism. Long-term vs. short-term ill patients gained weight at the same rate (~2 kg/wk) and were equally likely to be weight restored by discharge (>75% reached BMI ≥ 19 kg/m2 in both groups). At 6-month follow-up (n = 99), both groups had equivalent self-reported BMI, and depression, drive for thinness, body dissatisfaction, and bulimia scores. The only predictor of BMI ≥ 19 kg/m2 at follow-up was discharge BMI. The likelihood of a BMI ≥ 19 kg/m2 at follow-up was 5-fold higher for those with discharge BMI ≥ 19 kg/m2. Few studies of long-term ill inpatients with AN have examined the impact of full weight restoration on short-term outcomes. This study supports the therapeutically optimistic stance that, regardless of illness duration, hospitalized patients with AN benefit from gaining weight to a BMI ≥ 19 kg/m2.

scholarly journals Novel outpatient management of mild to moderate COVID-19 spares hospital capacity and safeguards patient outcome: The Geneva PneumoCoV-Ambu study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247774
Author(s):  
Chloé Chevallier Lugon ◽  
Mikaela Smit ◽  
Julien Salamun ◽  
Meriem Abderrahmane ◽  
Olivia Braillard ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Health Care Systems ◽  
University Hospital ◽  
High Rate ◽  
Ordinal Scale ◽  
Outpatient Management ◽  
Hospital Capacity ◽  
Hospitalization Costs ◽  
Novel Coronavirus ◽  
The Impact

Background Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease (COVID-19), is creating an unprecedented burden on health care systems across the world due to its high rate of pneumonia-related hospitalizations. This study presents recommendations for the outpatient management of moderate SARS-CoV-2 pneumonia implemented at the Geneva University Hospital, Switzerland, from April 4 to June 30, 2020 and evaluated the impact of these recommendations on patient safety, patient satisfaction, and overall hospital capacity. Methods Recommendations for the outpatient management of moderate pneumonia implemented in the Geneva University Hospital (PneumoCoV-Ambu) between April 4 and June 30, 2020, were evaluated prospectively. The primary endpoint was hospitalization. Secondary endpoints were: severity of COVID-19 disease based on a 7-points ordinal scale assessed at 1 and 2 months following SARS-CoV-2 infection; patient satisfaction using a satisfaction survey and the analysis of number of beds and costs potentially averted. Results A total of 36 patients with COVID-19-related pneumonia were followed between April 4 and May 5, 2020. Five patients (14%) were hospitalized and none died over a median of 30 days follow-up. The majority of patients (n = 31; 86%) were satisfied with the ambulatory care they received. These novel recommendations for outpatient management resulted in sparing an estimated potential 124 hospital bed-nights and CHF 6’826 per capita averted hospitalization costs over the three months period. Conclusions Recommendations developed for the outpatient management of COVID-19-related pneumonia were able to spare hospital capacity without increasing adverse patient outcomes. Widely implementing such recommendations is crucial in preserving hospital capacity during this pandemic.

Zaburzenia kardiologiczne u 13-letniej pacjentki z jadłowstrętem psychicznym

2017 ◽  
Vol 21 (3) ◽  
Author(s):  
Beata Kucińska ◽  
Ewa Smereczyńska ◽  
Bożena Werner
Keyword(s):  
Body Weight ◽  
Anorexia Nervosa ◽  
Structural Changes ◽  
Systolic Function ◽  
Left Ventricular ◽  
Severe Malnutrition ◽  
Systemic Complications ◽  
Cardiac Abnormalities ◽  
Intense Fear ◽  
Life Threatening

Anorexia nervosa (AN) is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight. This psychiatric disorder involves numerous systemic complications. Cardiac abnormalities are inherent with AN and they become more life-threatening as the anorexia nervosa becomes more severe. Anorexia nervosa has the highest mortality rate of all psychiatric disorders and the cardiac abnormalities are the leading cause of death because in AN structural, functional and rhythm-type changes can occur. The authors present the case of a 13-year-old girl with AN admitted to the hospital in serious general condition. Her major complaints were: fatigue and vertigo. Upon physical examination her nutritional status was estimated as severe malnutrition with BMI of 12.2 kg/m2. She was dehydrated, presented with bradycardia, muffled heart sounds and low blood pressure. Electrocardiography showed sinus rhythm with bradycardia and repolarization disturbances. Transthoracic echocardiography revealed pathological amount of fluid in pericardial sac, reduced left ventricular mass and systolic function, with decreased ejection fraction (EF – 49%) and shortening fraction (SF – 24%), as well as reduced systolic function of right ventricle with decreased fractional area change (FAC – 24%). She also presented the structural changes of atrio-ventricular valves: mitral valve prolapse (MVP), as well as slightly prolapsing leaflets of tricuspid valve with regurgitations. Improvement in cardiac function was observed with weight restoration. The authors highlight the importance of echocardiography check-up in patients with anorexia nervosa.

Comparison of Head and Neck Cancer Distribution in Turkish and Syrian Populations

2020 ◽  
Author(s):  
Gozde SERİNDERE ◽  
Behiye BOLGUL ◽  
Didar GURSOY ◽  
Sibel HAKVERDİ ◽  
Nazan SAVAS
Keyword(s):  
Head And Neck ◽  
Turkish Population ◽  
Developed Countries ◽  
University Hospital ◽  
High Rate ◽  
Pathology Report ◽  
Increased Risk ◽  
Turkish Patients ◽  
Risk Of Cancer ◽  
The Impact

Background: Although oral health improves in several countries, global problems are still present. Predictably, the disadvantaged and poor population groups in both developing and developed countries have high rate of malign disease. The aim of this study was to evaluate the prevalence of head and neck cancers (HNCs) and to compare them between Syrian and Turkish population. Methods: A total of 4570 patients confirmed to have HNC histopathologically from Hatay Mustafa Kemal University Hospital Pathology report archive were retrospectively evaluated. Among them, 452 were Syrian patients while 4118 were Turkish patients. Data were collected from 2010 to 2017. Gender and age information were taken from medical records. According to the pathological results, HNCs were classified. Results: In 474 patients, HNCs were inscriptived, of which 317 were in males and 157 in females aged 23–80 years with histologically approved cancer of head and neck area. Overall, 100 were Syrian patients while 374 were Turkish patients. In both Syrian and Turkish patients, the most observed HNC was squamous cell carcinoma (SCC). Conclusion: Nowadays, the prevalence of cancer is higher because of the excessive consumption of alcohol, tobacco, chewing, and smoking. For the higher cancer incidence in Syrian refugees, we thought that the impact of war such as stress may have been effective as well as the known several etiologic factors of cancer. For the increased risk of cancer, the early diagnosis of this become more important.  

scholarly journals Unveiling Metabolic Phenotype Alterations in Anorexia Nervosa through Metabolomics

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4249
Author(s):  
Laura Mayo-Martínez ◽  
Francisco J. Rupérez ◽  
Gabriel Á. Martos-Moreno ◽  
Montserrat Graell ◽  
Coral Barbas ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Behaviors ◽  
Metabolic Phenotype ◽  
Psychological Consequences ◽  
Review Of The Literature ◽  
Ongoing Research ◽  
Negative Body Image ◽  
Disease Mechanisms ◽  
Intense Fear ◽  
Fear Of Weight Gain

Anorexia nervosa (AN) is a mental disorder characterized by an intense fear of weight gain that affects mainly young women. It courses with a negative body image leading to altered eating behaviors that have devastating physical, metabolic, and psychological consequences for the patients. Although its origin is postulated to be multifactorial, the etiology of AN remains unknown, and this increases the likelihood of chronification and relapsing. Thus, expanding the available knowledge on the pathophysiology of AN is of enormous interest. Metabolomics is proposed as a powerful tool for the elucidation of disease mechanisms and to provide new insights into the diagnosis, treatment, and prognosis of AN. A review of the literature related to studies of AN patients by employing metabolomic strategies to characterize the main alterations associated with the metabolic phenotype of AN during the last 10 years is described. The most common metabolic alterations are derived from chronic starvation, including amino acid, lipid, and carbohydrate disturbances. Nonetheless, recent findings have shifted the attention to gut-microbiota metabolites as possible factors contributing to AN development, progression, and maintenance. We have identified the areas of ongoing research in AN and propose further perspectives to improve our knowledge and understanding of this disease.

scholarly journals The Anorexia Nervosa Care Pathway: Closing the Treatment Gap to Improve Care for Patients Admitted to Medical Hospitals

2021 ◽  
Author(s):  
Kathryn Allen ◽  
Kate O Brien ◽  
Marese O'Reilly ◽  
Deirbhile Henderson ◽  
Siobhan Machale ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Quality Of Care ◽  
Care Pathway ◽  
High Rate ◽  
Medical Complications ◽  
Hospital Inpatient ◽  
Improve Quality ◽  
Medical Monitoring ◽  
The Impact

Introduction: Medical complications of malnutrition and refeeding account for approximately half of deaths in anorexia nervosa (AN). The AN Care Pathway (ANCP) was introduced at our institution in 2016 to improve quality of care of patients admitted for medical observation and management. We report results from our review of medical complications and report the impact and adoption of the ANCP. Methods: The ANCP was developed in response to a need to improve quality of medical monitoring of patients with severe AN using Squire Guidelines and the Plan-Do-Study-Act cycle. All patients admitted to a medical hospital with AN between 2010-2020 were included after hospital inpatient enquiry and medical records were reviewed. Descriptive statistics were calculated using Stata (Statcorp). Results: Fifty-one patients (63 admissions) were included. Median BMI was 13.8 kg/m2 (11.9-22.5). After ANCP implementation in 2016, compliance with recommended daily ECG, thiamine and blood tests improved from 30% (n=8/27) to 86% (n=21/36). We report a high rate of medical complications of severe AN including anaemia (n=24, 47%), neutropoenia (n=18, 35%), abnormal liver bloods (n=15, 29%) and half developed refeeding syndrome. One-third patients had cardiovascular compromise including reduced cardiac contractility (n=13, 25%), pericardial effusion (n=7, 14%) and one death. Low BMI was associated with cardiovascular complications (mean BMI 13.5 kg/m2 vs 15.5 kg/m2, p=0.01) and neutropoenia (mean BMI 13.4 kg/m2 vs 15.4 kg/m2, p=0.02). Conclusion: Introduction of the ANCP improved quality of care during medical stabilisation. We report a high rate of medical complications of severe AN in patients admitted to a medical hospital. Use of multidisciplinary care protocols may contribute to quality improvement and improved consistency of care for this vulnerable population.

scholarly journals High Rate of Elder Abuse in the Time of COVID-19—A Cross Sectional Study of Geriatric and Neurology Clinic Patients

2021 ◽  
Vol 10 (19) ◽  
pp. 4532
Author(s):  
Karolina Filipska ◽  
Monika Biercewicz ◽  
Adam Wiśniewski ◽  
Renata Jabłońska ◽  
Agnieszka Królikowska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Functional Impairment ◽  
Low Income ◽  
Elder Abuse ◽  
Depression Scale ◽  
Rank Correlation ◽  
University Hospital ◽  
High Rate ◽  
Cross Sectional ◽  
The Impact

The ongoing COVID-19 pandemic is believed to have caused a sharp increase in the incidence of elder abuse (EA), including as a result of isolation, social distance combined with increased interpersonal stressors. Thus, the aim of this study is to determine the impact of the COVID-19 pandemic on the elder abuse rates and the characteristics of risk factors. A total of 347 patients hospitalized in the Department of Neurology and Department of Geriatrics at University Hospital No. 1 in Bydgoszcz were selected as subjects for the analysis. The tools used in the study are: Authors-Designed Questionnaire, the Vulnerability to Abuse Screening Scale, the Geriatric Depression Scale and the Activities of Daily Living Scale. Descriptive statistics, chi-squared tests, Spearman’s rank correlation test, and logistic regression analyses were used. In the studied population, nearly 45% of the elderly were victims of violence. This represents an increase of more than 6 percent compared to the pre-pandemic. The most common type of EA was psychological abuse (72.3%). In the final models, the risk factors include, among others, low income (OR = 3.60, 95% CI = 1.93–6.72), chronic diseases (OR = 2.06, 95% CI = 1.28–3.31), poor relationship with the family (OR = 3.26, 95% CI = 1.96–5.43), and moderate and severe depression (OR = 18.29, 95% CI = 10.24–32.69; OR = 18.49, 95% CI = 3.91–87.30, respectively). Moreover, moderate functional impairment 5.52 times more often and severe functional impairment 21.07 times more likely to predispose to EA. People who suffered from COVID-19 are 1.59 times more likely to be victims of EA (95% CI = 1.03–2.46). In this study, we saw significant increases in EA rates during the COVID-19 pandemic.

Atypical Anorexia Nervosa

2018 ◽  
pp. 279-287
Author(s):  
Nadia E. Saldanha ◽  
Khalida Itriyeva
Keyword(s):  
Weight Loss ◽  
Body Image ◽  
Anorexia Nervosa ◽  
Weight Gain ◽  
Mental Disorders ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Intense Fear ◽  
Atypical Anorexia Nervosa ◽  
Fear Of Weight Gain

Atypical anorexia nervosa is defined in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) as a disorder that shares the same diagnostic criteria as anorexia nervosa (AN), including dysmorphic body image, intense fear of weight gain, and restriction of energy intake, with the exception that patients with atypical AN present at a weight that is at or above the normal range despite a significant weight loss. Patients with atypical AN share many of the same medical and psychological complications and comorbidities as those with AN but with some differences in the way they are manifested. Treatment for these patients includes medical, nutritional, and psychological aspects of care, but choosing the appropriate goal weight and understanding the expected prognosis for these patients remain areas of research and discussion.

scholarly journals Interactions of Consanguinity and Number of Siblings with Childhood Acute Lymphoblastic Leukemia

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Ameer Kakaje ◽  
Mohammad Marwan Alhalabi ◽  
Ayham Ghareeb ◽  
Bahjat Karam ◽  
Bassam Mansour ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Positive Family History ◽  
University Hospital ◽  
Fourth Degree ◽  
Childhood All ◽  
Prognostic Features ◽  
Fab Classification ◽  
Complete Blood Counts ◽  
The Impact

Acute lymphoblastic leukemia (ALL) is a common malignancy in children. Consanguinity has a high prevalence in developing countries and increases the probability of homozygosity for many genes which may affect ALL and its prognosis. We conducted a study to explore the impact of consanguinity and number of siblings on ALL as there are currently no studies to describe this effect. Data were collected from patients’ records from the Children’s University Hospital of Damascus University, which is the major cancer centre for children in Syria. This study included 193 children with ALL over one year. Number of siblings was not with the French–American–British (FAB) classification, gender, ALL subtype, or risk of ALL children. When comparing consanguinity degrees and complete blood counts at diagnosis, significant contradicting data were found in the third-degree and fourth-degree consanguinity when compared to one another and to not having consanguineous parents as third degree consanguinity was associated with normal platelets but lower WBC counts, and fourth-degree consanguinity was associated with normal haemoglobin levels and WBC counts, but lower platelet counts. Having consanguineous parents was also associated with acquiring ALL at an older age, L2 FAB classification, having a positive family history for malignancies, and not having hepatosplenomegaly ( P < 0.05 ). Although L2 is known to be a poor prognosis indicatory, no association was found with consanguinity and risk. Finally, no association was found with ALL subtype or risk ( P > 0.05 ). Although consanguinity and number of siblings have affected some variables and prognostic features of childhood ALL, the aetiology is not clear and we need further studies to clarify such an association as this will help in optimising therapy and accurately determine the risk.

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