Parental experiences of the liminal period of a child’s fatal illness

The article offers a description of parents’ experiences of their child’s ultimately fatal illness as it unfolds over the successive stages of medical treatment, in the context of the liminality theory. The parents ( N = 23) were interviewed 1–4 years after their child’s death. The research method involved conducting narrative interviews with parents in order to obtain a spontaneous narration of the child’s illness as it unfolded. The grounded theory approach, including the narrative and performative aspects of such parental utterances, was applied as the main research strategy. The results provide insight into the main areas and processes of common parental experiences, such as the pervasive sense of becoming trapped in timelessness and ambiguity. Further states reported by parents included oscillating between a distancing stance and involvement, and a dualistic relationship with medical staff and the medical system: between alignment and disharmony. The study indicates the importance of treating delivery of such a diagnosis as a process rather than as a one-time event. The sense of ambiguity is treated as a kind of necessary parental coping mechanism, whilst the sense of timelessness gives parents a unique sense of time in which they do not have to think about the child’s potentially imminent death.

Association Between Cardiovascular Risk Factors and the Severity of Coronavirus Disease 2019: Nationwide Epidemiological Study in Korea

Background: Acute respiratory viral infections can result in cardiovascular involvement, with such patients having a significantly higher mortality rate than those without cardiovascular involvement. Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, it is important to determine whether cardiovascular risk factors are associated with the severity of COVID-19.Methods: These nationwide data were provided by the Korea Disease Control and Prevention Agency. We defined a patient as having a “critical illness” if they required more than invasive mechanical ventilation and “fatal illness” if they died.Results: Among the total 5,307 patients, 2,136 (40.8%) were male. The critical illness rate was 5.1% (males: 6.7, females: 4.0%) and the fatality rate was 4.54%. The multivariable analysis showed that age ≥60 years, male sex, diabetes mellitus, hypertension, heart failure, chronic kidney disease, cancer, and dementia were independent risk factors for critical illness. The risk scoring model showed the significance of multiple risk factors. Patients with four risk factors; old age (≥60 years), male sex, hypertension, and diabetes mellitus had a more than a 100 times higher risk for severe COVID-19 than those without these risk factors (OR; 95% confidence interval, 104; 45.6–240.6 for critical, 136.2; 52.3–3547.9 for fatal illness).Conclusions: This study demonstrated that cardiovascular risk factors are also significant risk factors for severe COVID-19. In particular, patients who have multiple cardiovascular risk factors are more likely to progress to severe COVID-19. Therefore, early and appropriate treatment of these patients is crucial.

Body mass index and severity/fatality from coronavirus disease 2019: A nationwide epidemiological study in Korea

Objective Obesity has been reported as a risk factor for severe coronavirus disease 2019 (COVID-19) in recent studies. However, the relationship between body mass index (BMI) and COVID-19 severity and fatality are unclear. Research design and methods This study included 4,141 COVID-19 patients who were released from isolation or had died as of April 30, 2020. This nationwide data was provided by the Korean Centers for Disease Control and Prevention Agency. BMI was categorized as follows; < 18.5 kg/m2, 18.5–22.9 kg/m2, 23.0–24.9 kg/m2, 25.0–29.9 kg/m2, and ≥ 30 kg/m2. We defined a fatal illness if the patient had died. Results Among participants, those with a BMI of 18.5–22.9 kg/m2 were the most common (42.0%), followed by 25.0–29.9 kg/m2 (24.4%), 23.0–24.9 kg/m2 (24.3%), ≥ 30 kg/m2 (4.7%), and < 18.5 kg/m2 (4.6%). In addition, 1,654 (41.2%) were men and 3.04% were fatalities. Multivariable analysis showed that age, male sex, BMI < 18.5 kg/m2, BMI ≥ 25 kg/m2, diabetes mellitus, chronic kidney disease, cancer, and dementia were independent risk factors for fatal illness. In particular, BMI < 18.5 kg/m2 (odds ratio [OR] 3.97, 95% CI 1.77–8.92), 25.0–29.9 kg/m2 (2.43, 1.32–4.47), and ≥ 30 kg/m2 (4.32, 1.37–13.61) were found to have higher ORs than the BMI of 23.0–24.9 kg/m2 (reference). There was no significant difference between those with a BMI of 18.5–22.9 kg/m2 (1.59, 0.88–2.89) and 23.0–24.9 kg/m2. Conclusions This study demonstrated a non-linear (U-shaped) relationship between BMI and fatal illness. Subjects with a BMI of < 18.5 kg/m2 and those with a BMI ≥ 25 kg/m2 had a high risk of fatal illness. Maintaining a healthy weight is important not only to prevent chronic cardiometabolic diseases, but also to improve the outcome of COVID-19.

Caligula: a neuropsychiatric explanation of his madness

ABSTRACT Gaius Julius Caesar Augustus Germanicus, better known as Caligula, (12 CE to 41 CE) was the third Roman emperor and ruled only four years. Throughout his life he experienced several traumatic events, and, in addition, historians mention some premorbid conditions that could cause him to become the monster that most historians know today. When Caligula was 25 years old, he suffered a near-fatal illness that turned his story around. One possible cause was lead poisoning due to the high consumption of wine, which contained lead, by Roman patricians. On the other hand, it is plausible that Caligula experienced epilepsy that began in childhood, later experienced status epilepticus in 37 CE, which triggered an epileptic psychosis with the consequent psychopathic and paranoid changes that led him to the madness noted by historians.

Effect of early oxygen therapy and antiviral treatment on disease progression in patients with COVID-19: A retrospective study of medical charts in China

Background Until now, no antiviral treatment has been proven to be effective for the coronavirus disease 2019 (COVID-19). The timing of oxygen therapy was considered to have a great influence on the symptomatic relief of hypoxemia and seeking medical intervention, especially in situations with insufficient medical resources, but the evidence on the timing of oxygen therapy is limited. Methods and findings Medical charts review was carried out to collect the data of hospitalized patients with COVID-19 infection confirmed in Tongji hospital, Wuhan from 30th December 2019 to 8th March 2020. In this study, the appropriate timing of oxygen therapy and risk factors associated with severe and fatal illness were identified and the effectiveness of antivirus on disease progression was assessed. Among 1362 patients, the prevalence of hypoxia symptoms was significantly higher in those patients with severe and fatal illness than in those with less severe disease. The onset of hypoxia symptoms was most common in the second to third week after symptom onset, and patients with critical and fatal illness experienced these symptoms earlier than those with mild and severe illness. In multivariable analyses, the risk of death increased significantly when oxygen therapy was started more than 2 days after hypoxia symptoms onset among critical patients (OR, 1.92; 95%CI, 1.20 to 3.10). Compared to the critically ill patients without IFN-a, the patients who were treated with IFN-a had a lower mortality (OR, 0.60; 95%CI, 0.39 to 0.91). Conclusions Early initiation of oxygen therapy was associated with lower mortality among critical patients. This study highlighted the importance of early oxygen therapy after the onset of hypoxia symptoms. Our results also lend support to potentially beneficial effects of IFNα on critical illness.

Corporate Social Responsibility during the Coronavirus Pandemic: An Interim Overview

The Coronavirus outbreak caught the world by surprise, spreading like wildfire and causing fatal illness to many. The ongoing pandemic and its implications have led to severe global socioeconomic disruption, halting most regular activities. Coping with the pandemic and its horrible consequences required to pull together all resources and unite efforts by individuals, organizations and governments. Businesses have embarked on an effort to support coping with the pandemic in various ways, as aligned with the concept of corporate social responsibility (CSR). The article reviews the various ongoing CSR efforts in the fight against the Coronavirus pandemic, serving better understanding on best CSR practices at times of crisis and in the afterwards ‘new normal’.

Drug rash with eosinophilia and systemic symptoms syndrome, a uncommon but fatal illness, paediatricians should be aware of: a case of 13 year old female child

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a fatal illness manifested by fever, morbilliform rash, multi systemic involvement and eosinophilic leucocytosis with about 10% mortality. Authors report DRESS syndrome in an adolescent girl due to anti-depressant and anti-psychotic which improved dramatically after withdrawal of offending drugs and starting of steroids

The Last Newspaper Fyodor Dostoevsky Read (Based on the Collections of Vladimir Dahl State Museum of the History of Russian Literature)

Throughout Dostoevsky's life, reading newspapers was one of the most important sources of his inspiration. Reading newspapers, Dostoevsky drew on real factual material that reflected both the characteristic phenomens of the postreform Russian reality and the most incredible “adventures” of lost human souls and hearts. Daily acquaintance with the latest news from Russian and world life was an essential necessity for Dostoevsky. Even while abroad, he regularly visited libraries to read the most recent Russian newspapers. Journalism was inherent in his type of thinking and personality. He began his literary career as a newspaper feuilletonist; in 1873–1874, he edited the Grazhdanin (The Citizen) weekly; in1876–1877, his monojournal A Writer's Diary was focused on Russian and European periodicals. In 1881, having completed his novel The Brothers Karamazov, Dostoevsky decided to resume the publication of A Writer's Diary. He prepared only one issue which came out on the day of his funeral. The manuscript collection of the Vladimir Dahl State Museum of the History of Russian Literature contains Anna Dostoevskaya’s collection that includes a memorial copy of the last newspaper read by Dostoevsky on the eve of his fatal illness, the Novoe Vremya (The New Time) newspaper, No. 1764 dated January 25 (February 6) 1881. This item is a valuable biographical material and allows one to put additional touches on the picture of Dostoevsky's intellectual life of his last days. The article provides an overview of the newspaper’s contents contextualized within Dostoevsky's spiritual, political, and aesthetic interests and particularly within the articles included in the first issue of The Diary of a Writer for 1881 and the preparatory materials for it.

The Last Newspaper Fyodor Dostoevsky Read (Based on the Collections of Vladimir Dahl State Museum of the History of Russian Literature)

Throughout Dostoevsky's life, reading newspapers was one of the most important sources of his inspiration. Reading newspapers, Dostoevsky drew on real factual material that reflected both the characteristic phenomens of the postreform Russian reality and the most incredible “adventures” of lost human souls and hearts. Daily acquaintance with the latest news from Russian and world life was an essential necessity for Dostoevsky. Even while abroad, he regularly visited libraries to read the most recent Russian newspapers. Journalism was inherent in his type of thinking and personality. He began his literary career as a newspaper feuilletonist; in 1873–1874, he edited the Grazhdanin (The Citizen) weekly; in1876–1877, his monojournal A Writer's Diary was focused on Russian and European periodicals. In 1881, having completed his novel The Brothers Karamazov, Dostoevsky decided to resume the publication of A Writer's Diary. He prepared only one issue which came out on the day of his funeral. The manuscript collection of the Vladimir Dahl State Museum of the History of Russian Literature contains Anna Dostoevskaya’s collection that includes a memorial copy of the last newspaper read by Dostoevsky on the eve of his fatal illness, the Novoe Vremya (The New Time) newspaper, No. 1764 dated January 25 (February 6) 1881. This item is a valuable biographical material and allows one to put additional touches on the picture of Dostoevsky's intellectual life of his last days. The article provides an overview of the newspaper’s contents contextualized within Dostoevsky's spiritual, political, and aesthetic interests and particularly within the articles included in the first issue of The Diary of a Writer for 1881 and the preparatory materials for it.