Introduction: Medical and psychiatric complications and treatment compliance are important considerations in determining the treatment program for patients with severe anorexia nervosa (AN). Clinical practice guidelines agree that an outpatient program is the first choice for the treatment of most eating disorders, but vary in supporting these programs for AN. However, inpatient care is known to be costly and the risk of relapse and readmission is high. This pilot study aimed to describe the first data on an Italian partial hospitalization care program for AN adolescents [high-level care treatment (HLCT)], evaluating its impact on patients' clinical status, average hospitalization time, and the hospital costs compared to inpatient treatment (IP).Methods: For this retrospective pilot study, we have selected a group of 34 females with AN aged 11–18 years, divided between those who followed inpatient treatment and those who received HLCT treatment; they were matched for age and severity. We investigated the differences in treatment and outcomes between the two groups in terms of heart rate, length of treatment, weight gain, psychological characteristics, and hospital costs. Statistics for non-parametric distributions were used to compare the two groups.Results: No differences between the two groups were found at admission. At discharge, patients in the HLCT group presented a lower number of in-hospital treatment days, a higher increase of weight, and a significant improvement in outcomes compared to the inpatient group. No significant differences were found in heart rate and hospital costs.Conclusions: This study represents a first comparison between inpatient care and the HLCT treatment program, which suggests that day hospital treatment could represent a meeting point between inpatient and outpatient treatment, combining the merits of both forms of treatment. Further studies are needed in order to better investigate the different treatment programs for severe AN in adolescence.
Background Immunization of vulnerable populations with distinct immunity often results in suboptimal immunogenicity, durability and efficacy. Methods To investigate the safety and the immunogenicity profiles of BNT162b2 mRNA COVID-19 vaccine among people living with HIV, we enrolled 28 HIV-infected patients under ART and 65 healthy controls (HCs) with no previous history of COVID-19. Immunogenicity was evaluated by measuring anti-RBD and anti-trimeric S Abs, along with the frequency of SARS-CoV-2 specific CD4 + CD40L + T cells. Samples were collected before vaccination (baseline, D0), at the second dose (D21), at 4 weeks (D28) and 6 months (D180) after the first dose. T and B cell phenotypes were investigated. Proteomic profiles at D0 and D28 were assessed with a multiplexed Proximity Extension Assay (Olink) on plasma samples. Results All vaccinated HIV-infected patients mounted anti-SARS-CoV-2 humoral responses between D21 and D28 similarly to HCs, albeit lower titers of anti-trimeric S Abs were detected at D28 compared to HC (p = 0.01). Only PBMCs of HIV+ demonstrated at D28 an impaired ability to expand their specific (CD40L+) CD4+ T populations. At 6 month-follow-up HIV+ showed similar maintenance of anti-SARS-CoV-2 Abs to HC. To explore whether these immunogenicity results could be linked to a particular proteomic outline, we correlated baseline protein levels to either humoral or cellular responses, identifying clusters of molecules involved in immune response regulation with inverse profiles between the two study groups. Conclusion Responses of ART-treated HIV+ compared to HC, characterized by distinct features especially within the proteomic compartment, supporting their eligibility to an additional dose, similarly to HC schedule.
Background E-cigarettes are devices which allow to aerosolize liquids containing nicotine or other substances. Ever since they were released on the market in 2006, the number of users have been constantly increasing, especially among adolescents, ranging from 7,6% to 9,3% in the age group 18–24 years old from 2014 to 2019. Hand in hand with the spread of E-cigarettes many have been the efforts to understand their impact on health. EVALI (E-cigarette or Vaping product use Associated Lung Injury) is an emerging condition with a heterogeneous presentation with several reported cases worldwide. We mean to report a case of EVALI in a 15-year-old female Caucasian patient, who's currently attending her clinic follow-up at Bambino Gesù Pediatric Hospital in Rome. Case presentation The patient was admitted to the Emergency Room due to acute respiratory failure in November 2020. At admittance, she was severely dyspneic (HR 120 bpm, SatO2 75%). As she was hospitalized amid the COVID-19 pandemics, she underwent a nasopharyngeal swab for SARS-CoV2, which turned out negative, and a chest CT scan. Chest CT scan showed a central ground grass pattern with peripheral sparing. At the anamnestic recall, it was disclosed she was an e-cigarette smoker and occasional marijuana user. The microbiological work-up proved only positive for Rhinovirus. Her clinical and radiological case was discussed with our radiologist who suspected EVALI. She was assisted through HFNC, antibiotical therapy and corticosteroids with a dramatic recovery within the first 48 h. Conclusions EVALI started being recognized a specifically nosological entity in summer 2019, with increasing cases being reported. No diagnostic criteria have been agreed upon yet, but its usual presentation includes respiratory, gastrointestinal and systemic symptoms of different degree and the diagnosis can be hypothesised in case the patient has an evocative clinical and radiological presentation and has been an E-cigarette smoker in previous 90 days. Due to the novelty of the condition and its heterogeneous presentation it is of interest to report the cases in which EVALI is identified to raise awareness about this emerging new-age disease.
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