Anorexia

The creative self in anorexics

Published on: 3rd March, 2021

OCLC Number/Unique Identifier: 8958449773

The article describes the interaction of anorexic patients, hospitalized in the Regional Pilot Psychiatric Service for the treatment of Anorexia in the Molinette Hospital of Turin, with the reading volunteering group. On the basis of said interaction, the Creative Self is searched for in patients and shows into be present in different ways. It seems anyway enhanced by the presence in the reading group.
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Palliative care approach to oncological patient – Main points

Published on: 31st March, 2020

OCLC Number/Unique Identifier: 8566861688

According to the World Health Organization definition, palliative care is an approach aimed at increasing the quality of life of patients and their relatives by addressing physical, psychosocial and spiritual needs and treating conditions early, such as pain while they are coming to terms with a life-threatening disease [1]. Palliative care services have started a rapid progress in developed countries such as Scandinavian countries, England and Canada since the beginning of 1990 [2]. Although palliative care cares for any patient who is in need of care, whether bed-bound or unable to look after themselves, one of the main area of interest is of course oncological patients and their relatives. Patients with advanced cancer, frequent sufferings from physical and psychological symptoms - primarily pain, reduced functional capacity, and reduced quality of life are in the scope of palliative care protocol [3]. The most common end-of-life symptoms and signs in palliative cancer patients are pain, anorexia, nausea, cachexia, weakness, dyspnea, ascites, anxiety, agitation, delirium, confusion and pressure sores. In order to achieve quality and continuous care in case management, a family doctor, specific branch specialist, nurse, dietician, psychologist, cleric, etc. should work together in a multidisciplinary approach and clinical guidelines and care protocols should be implemented [4]. However, it should be kept in mind that increasing the medication dose may not always be beneficial to the oncological patients in palliative services. The goal should always be maximum benefit with minimal tests and treatment. Palliative care does not aim to accelerate or postpone death; but it has many benefits in cancer patients and their relatives including the integration of the psychosocial and spiritual aspects of patient care into physical care, providing support for patients to live as active as possible until the last moment, improving the quality of life and the disease process, providing help and support in the grieving process [1,5]. Providing good care to advanced cancer patients requires that caregivers are educated and supported about their patients’ physical, psychological and social care needs. Balancing the physical and emotional needs of the caregivers will reduce the stress they experience, as well as increase the quality of life of their patients [6,7]. Professionalism in palliative care comes into play right at this point. There is no consensus in the medical world about by whom, when and to whom palliative care should be given. In this regard, the conflicts of opinion between specific branches such as anesthesia, internal medicine and neurology are inevitable. We think that the team leader should be a family physician or a palliative care specialist. The reason for this is the family medicine’s principles of core competencies including biopsycosocial, holistic, comprehensive approach and equal distance to specific branches. Of course when the palliative care specialist is the team leader the patient’s own family doctor still provides invaluable service because of his intimate and long-term knowledge about the patients. One key difference in some countries is that no distinction is being made between palliative and hospice care. Neither the insurance companies nor the state demands such classification because it doesn’t serve any practical purpose at the moment. However, in due time such distinction will be inevitable as one of the cost-cutting measure. Medical oncology will have to report about the expected survival of the cancer patients and it will further increase their workload given the exponential increase in cancer cases.
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Differences between anorexia patients and participants of the Minnesota hunger experiment: Consequences for treatment

Published on: 29th January, 2021

OCLC Number/Unique Identifier: 8915412109

The hunger experiment was carried out in 1944 by Anselm Keys and others in the American city of Minnesota. The aim was to investigate the consequences of starvation in order to be able to restore the health of hunger victims of the Second World War. How could they be treated in the best possible way to regain a healthy weight? For this purpose 36 physical and psychosocial healthy young men were selected from a large group of men who refused to serve in the American Army. They were examined very carefully in the period before the hunger experiment which lasted 6 months. In this period they received only two mails a day with half of the number of calories they were used to eat. This period of malinutrition was followed by 3 months of refeeding. Not only their weight recovered quite well, but also the psychosocial consequences of starvation disappeared completely [1]. 
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May we feed cancer?

Published on: 12th February, 2018

The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally. Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives.
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Acute Appendicitis: Hispanics and the Hamburger Sign

Published on: 20th November, 2019

OCLC Number/Unique Identifier: 8405001290

Objective: To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis. Methods: This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR). Results: A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia. Conclusion: It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.
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Gastrointestinal stromal tumor resulting in recurrent colic in a arabian horse gelding a report of case

Published on: 2nd November, 2020

OCLC Number/Unique Identifier: 8697203989

Background: A Grey 12-year-old Arabian endurance horse gelding was referred to the SHS Veterinary Center for anorexia, mild colic of 5 days duration, and melena of 1 day duration. The owner reported recurring colic, 12 episodes of mild colic in the previous year. Methods: On admission, vital signs were within normal limits and body condition score was estimated to be 3/9. Results: Packed cell volume (PCV) was 28% [reference range (RR): 31% to 47%] and plasma total protein was 58 g/L (RR: 60 to 80 g/L). Hematochezia was observed. Abdominal ultrasound examination detected no abnormalities. Over the next 12 h, the horse experienced hematochezia and several mild episodes of colic and death. A necropsy was performed. A mass arising from the right dorsal ascending colon near the base of the cecum and extending transmurally from the colonic mucosa into the mesocolon was a 8 cm × 5 cm × 8 cm firm, homogenous, tan mass. The portion of the mass that extended into the colonic lumen was pedunculated, with an ulcerated surface. The adjacent segments of colon were markedly reddened and edematous. Histologically, the mass was comprised of large interweaving sheets of small, spindle cells with ill-defined cell borders embedded in abundant myxomatous matrix. Tumor cells contained scant eosinophilic cytoplasm and oval to elongate nuclei with finely stippled chromatin and inconspicuous nucleoli. Mitotic figures were rare (1/10) high power fields. Tumor infiltrated between the muscularis interna and the muscularis externa at the myenteric plexi. Conclusion: Gross and histologic appearance, were consistent with a diagnosis of gastrointestinal stromal tumor.
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Hyperacute fatal course in a hypercalcemic crisis

Published on: 20th January, 2021

OCLC Number/Unique Identifier: 8899339891

A 39-year-old woman, with a not significant past medical history, entered the Emergency Department complaining about nausea, vomiting, constipation, anorexia, deep asthenia, and diffuse muscle aches with cramps. She referred sporadic diarrhea (one episode) the day before and a worsening headache in the past three days; she also complained about polyuria and polydipsia not investigated for one year. The clinical examination was not significant, apart from the evidence of skin and mucosal dryness, tachycardia, and diffuse abdominal pain. The laboratory tests revealed hypokalemia and elevated beta-human chorionic gonadotropin (β-hCG) plasma levels. An ultrasound abdominal imaging was consistent with kidney lithiasis. Suspecting a hyperemesis gravidarum in a patient with kidney lithiasis, a rehydrating therapy was administered as long as potassium reintegration. During the hospital stay, the patient became drowsy. A haemogasanalysis revealed very high calcium values: 3,379 mmol/L (n.v. 1,120-1,320 mmol/L). Lab tests confirmed very high levels of calcium 21,1 mg/dL (n.v. 9-10,5 mg/dL), as long as increased parathormone (PTH) > 3000 pg/mL (normal values 14-65 pg/mL), and hypokalemia (3,2 mEq/L n.v. 3,50 – 4,50). Ultrasound exam of the neck revealed the presence of a left parathyroid nodule measuring 2,5 x 1,6 cm. Before having time to start an appropriate therapy, the patient died.
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