Case report: Anorexia nervosa and unspecified restricting-type eating disorder in Jewish ultra-orthodox religious males, leading to severe physical and psychological morbidity

BackgroundYoung Jewish Ultra-Orthodox women usually show less disturbances in body image and eating in comparison to less religious communities. By contrast, problems with eating are highly unknown and unrecognized in Jewish Ultra-Orthodox males.AimTo investigate whether in Ultra-Orthodox males, restricting-type AN (AN-R) with highly obsessional physical activity and unspecified restricting eating disorder (ED) in the context of obsessive–compulsive disorder (OCD) would lead to severe physical and emotional morbidity.ResultsThe study included two groups: the first, 3 adolescents with AN-R developing severely increased ritualized obsessional physical activity in addition to restricting eating, requiring inpatient treatment because of severe bradycardia. These youngsters ignored the severity of their obsessional physical activity, continuing with it in hospital despite their grave medical condition. One student began extensive training for triathlon, whereas another student, upon remitting from AN, developed severe muscle dysmorphia. These findings suggest that young Ultra-Orthodox males with AN may develop obsessional physical activity to increase their muscle mass rather than to lose weight Another four Jewish Ultra-Orthodox males developed malnutrition in the context of severe OCD, with no evidence of dieting or body-image disturbances. These individuals developed highly obsessional adherence to different Jewish religious rules, including prolonged praying, asceticism, and overvalued strict adherence to Jewish Kashrut rules of eating, leading in all cases to severe food restriction. They were highly unaware of their severe weight loss and required hospitalization because of severe physical disturbances associated with malnutrition. Moreover, most did not cooperate with their treatment, and their ED-related obsessionality was mostly resistant to psychopharmacotherapy.ConclusionOwing to their highly ritualistic rigid way of life, combined with the need for excellency in studying, Jewish Ultra-Orthodox adolescent males with AN might be at a specific risk of developing severe physical disturbances if their illness is associated with highly perfectionistic obsessional physical activity. Second, Jewish Ultra-Orthodox religious males with OCD might be at a specific risk for severe undernutrition, as their rigid relentless observance of Jewish everyday laws might highly interfere with their eating

Traumatic Brain Injury during the SARS-CoV-2 Pandemics in Slovenia: A Single Center Study

(1) Background: The SARS-CoV-2 pandemic had a significant impact on the management of traumatic brain injury (TBI). We aimed to compare the clinical characteristics and outcomes of TBI patients before and during the SARS-CoV-2 pandemic.; (2) Methods: We analyzed depicted data from existing medical records on sex, age, mechanism of injury, clinical performance at admission and discharge, neuroimaging, laboratory values at admission, mortality, duration of hospitalization, and referrals after discharge from the traumatology department for all adult patients during the SARS-CoV-2 pandemic and a year before. Variables were compared using the Chi-square or t-test between both groups.; (3) Results: Most patients had mild (n = 477), followed by moderate (11) and severe (11) TBI. Mild TBI was less frequent during the SARS-CoV-2 period (n = 174 vs. n = 303). The incidence of high falls increased during the SARS-CoV-2 period (14.5% vs. 24.7%; p p p < 0.05) for patients treated during the SARS-CoV-2 period than before the SARS-CoV-2 period. There were no differences in GOSE; (4) Conclusions: our results demonstrated a significant impact of SARS-CoV-2 pandemic on the frequency, mechanism, and consequences of TBI, and may help improve care for our patients

Estudo retrospectivo (2007-2011) da casuística de cães com mastocitomas cutâneos atendidos em um hospital-escola

Neoplasms of mast cell origin are uncommon in most animal species. Although cases of cutaneous mastocitoma (CM) are rare in humans, it is the second most diagnosed cancer in dogs, accounting for approximately 20% of cutaneous tumors in this species. The age group most frequently affected is between eight and nine years, but it may occur in animals up to three weeks old. This study aimed to describe the epidemiological, hematological and histopathological characteristics of 73 dogs with cutaneous mast cell tumors attended between 2007 and 2011 by the Oncology Service of a teaching hospital in the state of São Paulo. Data collected included race, age, sex, weight, skin region affected, blood tests results at the first consultation and histopathological grading of dogs diagnosed with this neoplasia.En la mayoría de las especies animales, las neoplasias de origen mastocitaria son poco frecuentes. En medicina humana los casos de mastocitoma cutáneo (MC) suelen ser raros; no obstante, en la especie canina son la segunda neoplasia mas diagnosticada, representando aproximadamente el 20% de los tumores cutáneos. El rango etario con mayor frecuencia es entre los ocho y nueve años, pudiendo presentarse en animales jóvenes con hasta tres semanas de edad. Este estudio tuvo como objetivo describir las características epidemiológicas, hematológicas e histopatológicas de los perros con mastocitoma cutáneo, atendidos en el Servicio de Oncología Veterinaria de un hospital escuela en el estado de São Paulo, entre los años de 2007 y 2011, que representaron un total de 73 pacientes. Se obtuvieron datos referentes a la raza, edad, sexo, peso, región cutánea afectada, resultado de hemograma en la primer consulta y grado histopatológico de los perros diagnosticados con esta neoplasia.Na maioria das espécies animais, as neoplasias de origem mastocitária são incomuns. Raros são os casos de mastocitoma cutâneo (MC) em seres humanos; no entanto, na espécie canina, é a segunda neoplasia mais diagnosticada, representando aproximadamente 20% dos casos de tumores cutâneos. A faixa etária de maior ocorrência é entre oito a nove anos, podendo ocorrer em animais jovens com até três semanas de idade. Este estudo objetivou descrever as características epidemiológicas, hematológicas e histopatológicas de cães portadores de mastocitoma cutâneo atendidos pelo Serviço de Oncologia Veterinária de um hospital-escola do estado de São Paulo, entre os anos de 2007 e 2011, totalizando 73 pacientes. Foram obtidos os dados referentes a raça, idade, sexo, peso, região cutânea acometida, resultado do hemograma no momento da primeira consulta e graduação histopatológica de cães com diagnóstico da neoplasia

Thymus alterations and susceptibility to immune checkpoint inhibitor myocarditis

International audienceImmune checkpoint inhibitors (ICI) have transformed the therapeutic landscape in oncology. However, ICI can induce uncommon life-threatening autoimmune T-cell-mediated myotoxicities, including myocarditis and myositis. The thymus plays a critical role in T cell maturation. Here we demonstrate that thymic alterations are associated with increased incidence and severity of ICI myotoxicities. First, using the international pharmacovigilance database VigiBase, the Assistance Publique Hôpitaux de Paris–Sorbonne University data warehouse (Paris, France) and a meta-analysis of clinical trials, we show that ICI treatment of thymic epithelial tumors (TET, and particularly thymoma) was more frequently associated with ICI myotoxicities than other ICI-treated cancers. Second, in an international ICI myocarditis registry, we established that myocarditis occurred earlier after ICI initiation in patients with TET (including active or prior history of TET) compared to other cancers and was more severe in terms of life-threatening arrythmias and concurrent myositis, leading to respiratory muscle failure and death. Lastly, we show that presence of anti-acetylcholine-receptor antibodies (a biological proxy of thymic-associated autoimmunity) was more prevalent in patients with ICI myocarditis than in ICI-treated control patients. Altogether, our results highlight that thymic alterations are associated with incidence and seriousness of ICI myotoxicities. Clinico-radio-biological workup evaluating the thymus may help in predicting ICI myotoxicities

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially