Anorexia Nervosa: The physiological consequences of starvation and the need for primary prevention efforts.
Notice bibliographique
Résumé
CASE PRESENTATIONA 17-year-old girl was brought to the emergency department by her worried parents.The patient was described by her parents as having symptoms of fatigue, dizziness and syncope over the past few days.She also had no appetite, a weight loss of 11.4 kg over the past four months and a recent uncharacteristic pursuit to exercise.When the patient was further questioned, she complained of cold hands and feet, constipation, dry skin and hair, and headaches.Her social history revealed social withdrawal, depression, and irritability, as well as having difficulty concentrating and making decisions.Her performance at school had also fallen.The physical exam revealed a quiet, young girl who looked her age, was in no distress, but had cool peripheries.Her skin was slightly mottled in appearance, with some anhydrotic eczema of her extremities, and her blood pressure was difficult to auscultate.When obtained, it was lower than her usual values, at 84 systolic and 70 diastolic.Her pulse was 47 bpm, and irregularly irregular.Respiratory and abdominal examinations were normal.The patient however looked very underweight and thin.Her weight and height were 47 kg and 1.7 m, respectively; her calculated body-mass index (BMI) was 16.She also had a moderate loss of muscle mass and edema of her extremities.Further history taking from the patient, while alone, revealed that she had stopped menstruating seven months ago.There were no changes in sleep or any changes in bladder or bowel movements, and nausea and vomiting were denied.Her past medical history was remarkable for a stress fracture of her fibula and multiple admissions to hospital for depression, and she was also once admitted for suicidal ideation.Moreover, the patient denied any current laxative or diuretic use, and when asked about her diet, she stated that it consisted of yogurt and some fruit, with no meal at lunchtime while at school.Daily servings would not exceed a total of 750 kcal/day and her meals never contained any fat.She described herself as "fat…overweight" and her only pastime was exercising.When asked about her weight, she stated, "the more weight I lose, the more I wish to loose."She denied having any problems and explained that she was annoyed that her parents, friends, and teachers were concerned.It seems that the patient has very poor insight into her situation, and continues to perceive herself as healthy.Despite being aware that she is underweight, amenorrheic and bradycardic, she feels that she does not need to be in hospital.The social history revealed that the patient lives with her parents and two older siblings.When asked how her relationship is with her siblings, the patient replied, "I have never felt close to anyone…" The patient is a grade 12 student, and has considerable pressure from her parents to be an A student, and that they have very high expectations for her.She was involved in numerous extracurricular activities at school in the past; however, she is now preoccupied with her exercise goals, and has little time for other activities.English is a second language for the parents of the patient and there have been numerous problems in communication.There were parent-child relationship problems evident immediately on presentation.The mother has been unable to get the patient to eat at home; however, the family has been reluctant to have the patient admitted to hospital numerous times in the past.Family history revealed that a first cousin from the mother's side had been diagnosed with anorexia nervosa while in her teens.Laboratory values revealed anemia, leucopenia, hypoglycemia and numerous electrolyte disturbances.Her specific gravity in her urine was 1.005, indicating that she may have attempted to water load prior to
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».