Life-threatening Illness Research Articles

Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-PALL): a qualitative interview study.

Palliative care improves quality of life for people with life-threatening illnesses. There are longstanding inequalities in access to palliative care, with many people never identified as having palliative care needs, particularly frail older people, those with non-malignant disease, and people from ethnic minority backgrounds. Little is known about the process of identification of palliative care needs from a patient perspective. To provide new understanding into patient views and experiences of the process of identification of palliative care needs, and to explore the impact of identification on health care, if any, from a patient perspective. A qualitative interview study undertaken with patients and family carers in a major UK city. Semi-structured interviews were carried out with patients (and/or family carers) identified as being on general practice palliative care registers. An inductive thematic analysis was conducted to explore the data. Eleven participants were recruited: eight patients and three family carers. The following three interrelated themes were identified: 1) misconceptions about palliative care and unshared prognostic uncertainty hinder the identification of palliative care needs; 2) a compassionate, timely approach is required for identification of palliative care needs, with or without an identification tool; and 3) identification of palliative care needs is beneficial where it leads to proactive holistic care. A compassionate approach, sharing of prognostic uncertainty, and proactive primary care are key to timely, beneficial identification of palliative care needs. Future policy should ensure that identification is an adaptable, personalised process to meet the individual needs of people with advanced serious illnesses.

Особенности психопатологизации и тревожности женщин разного возраста в связи с психотравматизирующим фактором «жизнеугрожающее заболевание близкого»

The study is based on the assumptions that the nature of psychopathologization and anxiety in women whose traumatic event is a serious illness of a loved one differs from similar states of the respondents caused by other stressors of high intensity of anthropogenic nature, and that psychopathologization, specificity of anxiety and the level of post-traumatic stress are different for young and mature women. The research work revealed dif-ferences in the level of interpersonal sensitivity among respondents; greater expression is presented in those whose psychotraumatization is associated with a life-threatening illness of a loved one. Differences in the man-ifestations of deficient anxiety are shown – the highest values are found in respondents experiencing post-traumatic stress due to severe illness of a loved one. Psychopathologization of young and mature women was found to differ in the severity of paranoial symptoms. The results obtained can contribute to a more detailed differentiation of the consequences of contact with stressors of high intensity of anthropogenic genesis and are of a practice-oriented nature aimed at optimizing the activities of specialists of helping professions and em-ployees of palliative care services.

Prediction of conservative epitopes in the NS1 sequences of all four dengue virus serotypes

The Dengue virus, transmitted by Aedes aegypti mosquitoes, causes dengue fever, a life-threatening illness. NS1 (Nonstructural Protein 1) has been widely used as a biomarker for detecting dengue due to its early occurrence, high sensitivity, and specificity. The main objective of this study was to design an epitope-rich peptide capable of identifying all four dengue serotypes using homology modeling. Homology protein modeling, a computational approach, predicts the 3D structure of a protein by comparing its sequence to a known template. To achieve this goal, various bioinformatics tools, such as Blast/NCBI, BepiPred, Discotope 2.0, and HADDOCK, were utilized. As a result, there were 18 consensus sequences for the four Dengue serotypes from amino acid 12 to 344. However, the eight of them have shown the most highly scoring conservative sequence segments in BepiBred, Antigenicity, Beta turn, Surface accessibility, Flexibility, and Hydrophilicity. In the results of predicting epitopes, three conservative segments predicted to be the best antigens were selected. Combining the resulting parts, two potential NS1 peptides, containing 149 amino acids from positions 112 to 260, were identified and characterized in all four DENV strains. It is the sequence segment that will be selected for creating materials such as recombinant antigens and monoclonal antibodies for the diagnosis of dengue hemorrhagic fever in the next study.

Updated guidelines for chronic active Epstein-Barr virus disease.

Chronic active Epstein-Barr virus disease (CAEBV), formerly named chronic active Epstein-Barr virus infection, is characterized by systemic inflammation and clonal proliferation of Epstein-Barr virus (EBV)-infected T or NK cells. As CAEBV is a potentially life-threatening illness, appropriate diagnosis and therapeutic interventions are necessary for favorable clinical outcomes. Substantial evidence regarding the pathogenesis and treatment of CAEBV has been accumulated since previous guidelines for the diagnosis of CAEBV were proposed. To reflect this evidence, we updated the guidelines for the diagnosis and treatment of CAEBV to improve clinical management of the disease. The details of the updated guidelines are presented in this report. Diagnosis of CAEBV now requires confirmation of a high copy number of EBV genome and EBV-infected T or NK cells. An EBV DNA load ≥ 10,000IU/mL in whole blood is proposed as the diagnostic cutoff value for CAEBV in this updated guideline. A standard treatment approach for CAEBV has not been established, and hematopoietic stem cell transplantation (HSCT) is considered the only curative treatment. Chemotherapy can be administered to control disease activity before HSCT.

Drug Shortage - Impact on the supply of critical drugs

In the United States (US), drug shortages have been a particularly prevalent issue, especially concerning generic drugs and biologics. These shortages affect treatments for a wide range of diseases, from mild to moderate conditions to severe life-threatening illnesses. The scarcity of oncology-related drugs is particularly concerning, as these medications play a crucial role in cancer treatment and have a direct impact on human lives. In this article, we will discuss two such drugs, Cisplatin and carboplatin, examining their causes of the current shortage and exploring potential solutions that could help alleviate these drug shortages.

Paediatric Palliative Care in a Reference Centre of Inherited Metabolic Diseases.

Paediatric palliative care (PPC) has a significant role in improving the quality of life of children with life-limiting or life-threatening illnesses, diminishing symptom burden, and providing holistic support to patients and families. Inherited metabolic diseases (IMD) are a group of heterogeneous diseases that often present with severe neurologic impairment, needing lifelong care and challenging symptom management. Our aim was to characterize the cohort of patients with IMD followed by the paediatric palliative care team (PPCT) and to describe the provision of care provided. The descriptive analysis of demographic, clinical, and care delivery data of a cohort of paediatric patients was carried out with a confirmed diagnosis of IMD, followed in a Reference Centre, in the care of PPCT between 2018 and 2023. Thirteen (10%) of a total of 134 patients in the care of PPCT had a confirmed diagnosis of an IMD: 6 mitochondrial, 3 peroxisomal, 3 lysosomal, and 1 pterin metabolism disorder. The median age at referral was 9 years (0-18), the median duration of care was 2 years [2-4], median number of home visits in the last year was 2 [1-4], and median number of outpatient consults was 4 [2 -8]. Twelve patients (92%) had no autonomy in their activities of daily living. Neurologic (100%), gastrointestinal (92%), and respiratory (69%) symptoms were the main focus of care. All patients were polymedicated (5 or more different drugs). Nine (69%) had percutaneous gastrostomy and 2 (15%) had noninvasive ventilation. Median hospital admissions before and after starting care by PPCT were 4 and 1. Moreover, three patients died and one was at home. Mitochondrial, lysosomal, and peroxisomal disorders are complex multisystemic diseases that very often have no treatment intended to cure. These patients have a heavy symptom burden and frequent intercurrences. Addressing these symptoms is challenging, but PPC has proven to reduce hospital admissions with consequent improvement in quality of life. In the future, PPC should be available for all children and families with life-threatening conditions.

Kenyan palliative care providers’ and leaders’ perceptions of palliative care research needs and support to facilitate rigorous research

BackgroundPalliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.ObjectivesTo explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC providers and leaders.MethodsFocus groups (FGs) were conducted in November and December of 2018 using a semi-structured interview guide. FGs were audio-recorded, transcribed, and analyzed using a thematic content analysis approach.ResultsThree FGs were conducted (n = 22 participants). Ten themes related to PC research emerged, including research on: 1) beliefs about death, disease, and treatment to inform PC; 2) awareness about PC, 3) integration of PC within the health system; 4) understanding caregiver experiences and needs; 5) community health volunteers (CHVs) and volunteer programs; 6) evaluation of costs and benefits of PC; 7) treatment approaches, including complementary and alternative medicine (CAM) and advanced diagnostics at end of life; 8) other suggestions for research, 9) populations in need of PC research; and 10) resources for enabling research.ConclusionsKenyan PC providers and leaders identified key areas requiring increased scientific inquiry and critical resources needed to enable this research. These findings can help to focus future PC research in Kenya and encourage funding agencies to prioritize the issues identified.

Psychosocial-spiritual well-being is related to resilience and mindfulness in patients with severe and/or life-limiting medical illness

BackgroundImprovement of psychosocial-spiritual well-being in patients with life-threatening or life-limiting illness is desirable. Resilience and mindfulness are considered to be helpful for enhancing psychosocial-spiritual well-being. Mindfulness-based interventions have been shown to promote resilience to stress and enhance well-being. However, in medical patients, evidence for the associations between mindfulness and resilience is lacking. We hypothesize patients with higher levels of psychosocial-spiritual well-being demonstrate greater resilience and mindfulness.Methods200 patients (mean age = 50.2, SD = 15.5) with serious and or life-limiting illnesses were recruited from the NIH Clinical Center. Patients completed a demographic questionnaire, the NIH-HEALS measure of psychosocial-spiritual well-being, the Connor-Davidson Resilience Scale (CD-RISC-10), and the Mindful Attention Awareness Scale (MAAS). The demographic questionnaire also included a question on current stress level.ResultsThe NIH-HEALS was positively correlated to CD-RISC-10 (rs=0.44, p < 0.001) and MAAS (rs=0.32, p < 0.001). These findings were consistent across all three NIH-HEALS factors. Additionally, CD-RISC-10 and MAAS demonstrated a meaningful relationship to each other (rs=0.46, p < 0.001). All three constructs were inversely related to current stress level.ConclusionsFindings suggest that there is a meaningful relationship between psychosocial-spiritual well-being, mindfulness, and resilience. Mindfulness and resilience are positively correlated in a medical population. Clinical interventions aimed at enhancing psychosocial-spiritual well-being through mindfulness and resilience can be highly promising for patients with severe and or life limiting illness.

Religiosity and death anxiety among cancer patients: the mediating role of religious comfort and struggle.

Religiosity may serve as a personal source of support when people face a life-threatening illness, but it can also elicit stress. The main aim of this study is to show how various religious dimensions interplay in predicting death anxiety in patients diagnosed as having cancer. In the cross-sectional, descriptive-analytical research, 141 Polish patients who were hospitalized due to cancer were selected using sequential convenience sampling. Data were collected using the Centrality of Religiosity Scale, Religious Comfort and Strain Scale, and the Death Anxiety and Dying Distress Scale. The authors' results show that the effect of the centrality of religiosity on death anxiety is non-linear. We can also confirm the mediating role of religious comfort and struggles in the relationship between the centrality of religiosity and death anxiety. Thus, religious struggles appear to weaken the effect of religion on death anxiety, whereas religious comfort (contrary to expectation) does not enhance it. Int J Occup Med Environ Health. 2023;36(4):450-64.

Relational and Existential-Humanistic Supervision and Therapy for Adolescents with Life-Threatening Illness: From Cocoon to Butterfly

ABSTRACT This paper describes the flexible application of existential-humanistic (E-H) and relational approaches to supervision when working with adolescents with life-threatening illness. Powerful therapeutic work can occur through the balance of utilizing practical therapeutic interventions─including open-ended questions regarding existential anxieties, use of countertransference and somatic reactions, reflecting on values and priorities, dream interpretation, learning from each emotion, creativity, and what is psychological health─and understanding how an illness is processed through the patient’s unique cultural, family, medical, and relational history. The relational approach provides a balance to the E-H therapy emphasis on individuality in its focus on the complexity and adhesiveness of how early relational patterns and expectations are repeated throughout life. The E-H approach, on the other hand, provides a richness and depth to adolescents’ anxieties and desire for freedom and choice. The language of agency, uncertainty, groundlessness, and responsibility can be particularly relevant to the turbulence of this developmental stage. The ultimate goal of supervision is that the supervisor becomes part of the supervisee’s “internal chorus” along with other teachers, therapists, and mentors when dealing with future clinical challenges.

Mathematical study of fractal-fractional leptospirosis disease in human and rodent populations dynamical transmission

In both industrialized and developing nations, leptospirosis is one of the most underdiagnosed and under-reported diseases. It is known that people are more likely to contract a disease depending on their employment habits and the environment they live in, which varies from community to community. The absence of global data for morbidity and mortality has contributed to leptospirosis' neglected disease status even though it is a life-threatening illness and is widely acknowledged as a significant cause of pulmonary hemorrhage syndrome. This study aims to examine the impact of rodent-borne leptospirosis on the human population by constructing and evaluating a compartmental mathematical model using fractional-order differential equations. The model considers both the presence of disease-causing agents in the environment and the rate of human infection resulting from interactions with infected rodents and the environment. Through this approach, the research investigates the dynamics and implications of leptospirosis transmission in the context of human-rodent interactions and environmental factors. We create a fractal-fractional model using the mittag-leffler kernel. The positivity and boundedness of solutions are first discussed. The model equilibria and fundamental reproduction number are then presented. With the use of the Lyapunov function method, the solutions are subjected to global stability analysis. The fixed-point theory is used to derive the fractional-order model's existence and uniqueness. Solutions are produced using a two-step Lagrange polynomial in the generalized form of the Mittag-Leffler kernel to explore the effect of the fractional operator with numerical simulations, which shows the influence of the sickness due to the effect of different parameters involved. Such a study will aid in the development of control strategies to combat the disease in the community and an understanding of the behavior of the Leptospira virus.

Clinical treatment for persistent inflammation, immunosuppression and catabolism syndrome in patients with severe acute pancreatitis (Review).

Severe acute pancreatitis (SAP) is a severe disease with a high prevalence and a 3-15% mortality worldwide, and premature activation of zymogen for any reason is the initial factor for the onset of SAP. Gallstone disease and heavy alcohol consumption are the two most common etiologies of SAP. Persistent inflammation, immunosuppression and catabolism syndrome (PICS) is a life-threatening illness, and there are no effective treatments. The relapse state of PICS mainly leads to high mortality due to septic shock or severe trauma, both of which are dangerous and challenging conditions for clinicians. Thus, it is important for medical staff to identify patients at high risk of PICS and to master the prevention and treatment of PICS in patients with SAP. The present review aims to increase the understanding of the pathogenesis of PICS, produce evidence for PICS diagnosis and highlight clinical treatment for PICS in patients with SAP. With this information, clinical workers could implement standardized and integrated measures at an early stage of SAP to stop its progression to PICS.

A qualitative exploration of the spiritual wellbeing of women with advanced cervical cancer in Ghana.

Spiritual wellbeing is one of the most important aspects of human health, alongside physical, psychological and social factors. Religiosity/spirituality can play a critical role in the lives of people experiencing life-threatening illnesses, such as cervical cancer. Most women with cervical cancer in Africa, including Ghana, are diagnosed at the advanced stage. These women lean on their spiritual connections for strength during their illness. Despite the fact that numerous studies have been conducted on the relevance of religiosity/spirituality in the experience of cancer in other jurisdictions, the same cannot be said about Ghana. The study aims to fill this gap in the literature. To explore the spiritual wellbeing of women diagnosed with advanced cervical cancer in Ghana. A qualitative explorative design was employed, with purposive sampling used to recruit 15 women with advanced cervical cancer from a cancer treatment centre of a teaching hospital in Ghana. Individual face-to-face interviews, lasting between 45-90 minutes, were used to gather information. Interviews were audio taped with participants' consent. Data were analysed using thematic content analysis. The following sub-themes were identified within one overarching theme of the spiritual wellbeing of women with advanced cervical cancer: the meaning of illness and acceptance; a sense of hope and religiosity; uncertainty; and the will to live. Many participants believed they were bewitched, and the devil was responsible for their cervical cancer. Healthcare providers should adopt a multi-disciplinary approach and widen their care strategies to include spirituality, to enhance the treatment outcomes of women living with advanced cervical cancer.

Nursing care for symptoms seen in patients undergoing palliative surgery – a retrospective study

Introduction and aim. Palliative care is an approach to improve the quality of life of patients and their families facing problems associated with life-threatening illnesses or old age, to manage their pain, distress, and other symptoms, improving their quality of life, and providing psychological support. This study was designed to identify the care practices planned by nurses for the health issues of palliative surgical patients. Material and methods. This is a retrospective, cross-sectional, descriptive study. The data was collected from digital records of the two state hospitals in the Western Black Sea Region of Turkey between January 2019 and January 2020. The research was completed with a total of 391 data of patients undergoing palliative surgery. Frequency and percentage distributions were used in descriptive statistics. Results. The frequency of symptoms observed in patients were determined as cough and sputum (81.8%), dehydration (73.9%), dyspnea (71.9%), fatigue (49.9%), loss of appetite-weight (49.9%), insomnia (44%), pain (37.6%), nausea (29.2%), and constipation (23.8%). The planned nursing diagnoses for these symptoms were identified as risk for falls, imbalanced nutrition, risk for impaired skin integrity, risk for infection, risk for aspiration, deficient knowledge, risk for impaired respiratory function, constipation, ineffective airway clearance, pain, risk for deficient fluid volume, sleep deprivation, impaired gas exchange respectively. Conclusion. This study highlights the insufficient planning of nursing care for the symptoms of palliative surgical patients receiving palliative care in our country. Therefore, it is recommended that palliative care nurses be supported with in-service training on appropriate care planning topics.

A Systematic Review on Outcomes of Patients with Heatstroke and Heat Exhaustion.

Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness. In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified. A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated. This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.

Abstract P136: Association Of Undernutrition Severity With Development Of Incident Hypertension In Youth.

Cardiovascular disease (CVD) is a leading cause of death despite improved treatment, largely due to limitations in primordial prevention. Youth with chronic health conditions have higher risk of CVD and undernutrition, however it is unknown if undernutrition causes hypertension (HTN). Our goal was to investigate if undernutrition in youth is associated with incident HTN. Interim analysis of electronic health record data from a bioinformatics-driven retrospective cohort study. Inclusion criteria were ages 6 months - 18 years with a first occurrence of undernutrition by ICD-10 code, weight-for-height z-score &lt;-2, or BMI z-score &lt;-2 in outpatient clinic or inpatient hospital encounters between 2015-2022. Exclusion criteria were premature birth, low birth weight, or diagnosis of heart disease, liver disease, or chronic kidney disease at index date. We created a Kaplan Meier curve and log-rank test. Of 8,878 participants, 2,569 (58%) were males. We found that more severe undernutrition was associated with decreased risk of HTN. More severe undernutrition was associated with decreased risk of HTN. However, only first instances of blood pressure in HTN range were included. Ongoing steps include refining the undernutrition population, building a Cox regression model, and developing a matched control population to compare the risk of HTN to. Concurrently, we have an animal study to further assess the impact of undernutrition on HTN development. Determining if undernutrition is a causal risk factor for HTN, which often leads to additional serious and life-threatening illnesses, will allow for earlier screening and intervention to prevent clinical diagnoses later in life.

The Need for Advance Care Planning as a Pivotal Means for Respecting the Patient’s Will in Poland: Learning Points from Swiss and Australian Models

Abstract Self-determination is pivotal for a patient’s autonomy. Decisions at the end of life should reflect the human right to decide on the last days of life according to personal beliefs, philosophy, preferences, and values. Advance Care Planning (ACP) aims to ensure that patients receive medical care consistent with their values, goals, and priorities during progressive life-threatening chronic illness. We present decades-long experience of the implementation of ACP in different legal systems, in Switzerland and Australia, and the current legal situation of pro futuro statements in Polish law. Irrespective of jurisdiction and despite the apparent benefits of ACP, its implementation may face numerous impediments, i.e. poor public health messaging, a lack of skilled, trained personnel to deliver and sustain ACP initiatives, misunderstanding of the practical application of an advance care directive in real terms, and misperception of ACP as a form of crypto-euthanasia. Addressing these impediments would be a prerequisite for its successful national implementation. Furthermore, successful implementation needs public dialogue, collaboration between legislators and healthcare professionals, and engagement with the public, patients, and caregivers to foster a greater understanding of the true meaning of self-determination.

An AI-powered patient triage platform for future viral outbreaks using COVID-19 as a disease model

Over the last century, outbreaks and pandemics have occurred with disturbing regularity, necessitating advance preparation and large-scale, coordinated response. Here, we developed a machine learning predictive model of disease severity and length of hospitalization for COVID-19, which can be utilized as a platform for future unknown viral outbreaks. We combined untargeted metabolomics on plasma data obtained from COVID-19 patients (n = 111) during hospitalization and healthy controls (n = 342), clinical and comorbidity data (n = 508) to build this patient triage platform, which consists of three parts: (i) the clinical decision tree, which amongst other biomarkers showed that patients with increased eosinophils have worse disease prognosis and can serve as a new potential biomarker with high accuracy (AUC = 0.974), (ii) the estimation of patient hospitalization length with ± 5 days error (R2 = 0.9765) and (iii) the prediction of the disease severity and the need of patient transfer to the intensive care unit. We report a significant decrease in serotonin levels in patients who needed positive airway pressure oxygen and/or were intubated. Furthermore, 5-hydroxy tryptophan, allantoin, and glucuronic acid metabolites were increased in COVID-19 patients and collectively they can serve as biomarkers to predict disease progression. The ability to quickly identify which patients will develop life-threatening illness would allow the efficient allocation of medical resources and implementation of the most effective medical interventions. We would advocate that the same approach could be utilized in future viral outbreaks to help hospitals triage patients more effectively and improve patient outcomes while optimizing healthcare resources.

Pediatric Phagophobia: A Systematic Review and a Case Report of Pharmacological Interventions

Background: Phagophobia is characterized by conditioned excessive fear of swallowing or choking that is usually triggered by an incident. It usually leads to avoidance of certain types of food or, in severe forms, a complete refusal to eat solid food and/or liquids. The condition is commonly associated with physical and psychological symptoms impacting the health condition of the individual due to deprivation of essential nutrients. Case Presentation: A 12-year-old boy developed acute onset fear of swallowing (Phagophobia) following a dream he had of someone choking. This was exacerbated by watching an online video of a person choking. This has led to an avoidance of solid food and dependence on soft food and liquids. Fear of swallowing along with food avoidance has led to malnutrition, weight loss, and several physical complaints for which the patient was admitted under pediatric care. A course of Cognitive Behavioral Therapy (CBT) resulted in limited response and was augmented with fluoxetine. Full remission was achieved within six weeks. Methods: A systematic review of all peer-reviewed English literature was performed for articles related to the pharmacological treatment of pediatric phagophobia (0-18 years) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 17 case reports were identified describing 17 children with phagophobia (females = 70 %). The mean age was 9.3 and the average was between 2 and 15 years who were diagnosed with choking phobia/ phagophobia or different but equivalent diagnoses like Avoidant/Restrictive Food Intake Disorder or Post Traumatic Feeding Disorder. Different classes of medications were used in variable doses for different durations which were associated with significant improvement in eating patterns and reduction in fear and anxiety associated with eating. Conclusion: Phagophobia is a serious and potentially life-threatening illness that can cause physical complications and functional impairment in the psychosocial aspect. Pharmacological treatment can be a beneficial and safe option either alone or in combination with therapeutic interventions for children presenting with phagophobia.

An Easy-to-Use Prehospital Indicator to Determine the Severity of Suspected Heat-Related Illness: An Observational Study in the Tokyo Metropolitan Area.

Rapid hospital arrival decreases mortality risk in heat-related illnesses. We investigated an easy-to-use indicator of life-threatening severity of heat-related illnesses in a community setting to enable quick hospitalization by using data extracted from prehospital transportation records of a database from 2016 that included information on the clinical severity of suspected heat-related illnesses in patients (n = 2528) upon hospital arrival. Patient-related risk factors (adjusted odds ratio, aOR [95% confidence interval, CI]) included age, vital signs, location of the patient, and illness severity, and respiratory rate (3.34 [1.80-6.22]), heart rate (2.88 [1.57-5.29]), axillary body temperature (7.79 [4.02-15.1]), and consciousness level (38.3 [5.22-281.1]) were independent risk factors for heat-related illness severity. On-site blood pressure was not an independent factor for illness severity. Heart rate > 120 beats/min, respiratory rate > 24 breaths/min, and temperature > 38.6 °C (highest areas under the receiver operating characteristic curves [95% CI]: 0.80 [0.75-0.87]; 0.73 [0.67-0.81]; and 0.83 [0.77-0.91], respectively) predicted life-threatening illness severity. Changes in the vital signs of patients with heat-related illnesses, particularly tachycardia and tachypnea, constitute sensitive, easy-to-use indicators that facilitate rapid identification of severity by laypersons and transport of patients before aggravation to a life-threatening situation.