L'intervento terapeutico nelle strutture semiresidenziali e residenziali

I disturbi dell'alimentazione vanno considerati come disturbi di natura psichiatrica ma le imponenti complicanze organiche, talvolta devastanti per il paziente, incrementano non solo il tasso di mortalità ma anche di cronicità e d'invalidità e li pongono in una terra di confine per il sovrapporsi di aspetti psichiatrici e internistici che ne rendono difficoltoso non solo l'inquadramento nosografico ma anche l'approccio terapeutico. Inoltre, non si deve dimenticare che il cibo, e le modalità con cui ci si relaziona a esso, non esprime semplicemente un valore nutrizionale ma è un elemento fondante della nostra cultura, della nostra civiltà e della nostra struttura mentale. Questo libro cerca di vagliare tutte le varie e possibili opzioni terapeutiche e illustra le principali linee di ricerca attraverso una trattazione focalizzata su specifici filoni di indagine. Ogni capitolo è svolto da colleghi qualificati ed esperti nel trattamento dei DA appartenenti a varie specialità mediche e psicologiche... Il libro è principalmente indirizzato a chi si accinge ad affrontare i DA, medici di medicina generale, pediatri di libera scelta, specializzandi, psicologi, psichiatri o internisti anche senza una particolare esperienza in merito ma desiderosi di ampliare il proprio bagaglio culturale e umano

My Body and Me: Self-Injurious Behaviors and Body Modifications in Eating Disorders\u2014Preliminary Results

We investigated self-injurious behaviors and body modification practices in eating disorder patients, considering different ED diagnoses and illness severities. Of the total sample, 50.9% showed at least one form of self-injury and 50.9% reported at least one tattoo, piercing, or both. Patients reporting only body modifications showed more positive feelings toward their bodies, higher levels of self-esteem, less impulsivity, depression, and anxiety, and lower levels of social dysfunction than those reporting only self-injury or both self-injury and body modifications. Self-injury was influenced by both diagnosis and severity of disorders

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)