The bidirectional connection between family functioning and psychopathology: A network analysis in a large sample of adolescents with anorexia nervosa and their parents.

Family functioning is a risk and maintaining factor for anorexia nervosa (AN). This study aims to identify specific areas of family functioning according to adolescents and parental perspectives associated with eating and general psychological symptoms in people with AN. Four-hundred-forty-five adolescents with AN or atypical AN and their parents were enrolled. Adolescents completed the Eating Disorder Inventory-3, the Youth Self-Report questionnaire, and the Family Assessment Device (FAD). Their parents filled in the FAD. A network analysis was conducted including all subscales. The bridge function analysis was applied to identify the bridge nodes connecting each community constituted of family functioning perception with the communities of adolescents' eating and general psychological symptoms. Family communication was the node most strongly connecting fathers and mothers' perception of family functioning and adolescents' eating symptoms. Problem solving was the node with the highest bridge expected influence between mothers' family functioning and adolescents' general psychopathology. General functioning and problem solving were the bridge nodes between adolescents' view of family functioning and eating and general psychopathology. Maturity fear, interpersonal insecurity, and interpersonal alienation were the bridge nodes between adolescents' eating symptoms and mothers, fathers, and adolescents' family functioning communities respectively. Family members must be involved in the therapeutic process to improve family communication and problem solving diverting their attention toward emotional needs and interpersonal difficulties of adolescents with AN. Developing autonomy and independence from parents and building trustworthy relationships with peers may be favored by improving familiar dynamics and may contribute to prevent the maintenance of AN.

Psychiatric comorbidities and dehydration are more common in children admitted to the emergency department for eating disorders in the COVID-19 era.

PURPOSE: Since the beginning of COVID-19 pandemic, social distancing and home confinement had a significant impact on children, especially on those with eating disorders (ED). The primary objective of this retrospective study was to describe and analyze the demographic and clinical profiles of children presenting with ED during the COVID-19 pandemic. METHODS: We conducted a retrospective review of clinical charts of patients with ED younger than 18 years who accessed the emergency department of the Bambino Gesù Children's Hospital, Rome, between March 2019 and March 2021. Of these, we reported and compared the demographic, clinical and laboratory data before and after the COVID-19 pandemic and looked for predictors of ED severity. RESULTS: A total of 211 admissions for ED were recorded. The patients, mostly females (86.3%) were on average 14.1 years old. The mean weight loss on admission was 11 kg. Bradycardia was observed in 31.3% of the study sample. 16.6% of patients had an associated psychiatric disorder and 60.2% required psychotropic drugs. 68.7% of the patients required hospitalization. Respectively, 96 and 115 patients were admitted before and during the COVID-19 pandemic. The latter were hospitalized more (78.3 vs 57.3%; p = 0.001), yet for less time (19 vs 26 days; p = 0.004), had a higher mean serum creatinine (0.68 vs 0.47; p < 0.001) and were more frequently diagnosed with an associated psychiatric disorder (23.5 vs 8.3%; p = 0.003). CONCLUSION: Our study shows a significant increase of hospitalizations of children with ED during the COVID-19 pandemic, along with a shorter length of stay, more psychiatric comorbidities, and some distinctive features at the laboratory work-up, such as an increase of serum creatinine and/or a reduction of serum albumin. LEVEL OF EVIDENCE: III, evidence obtained from well-designed cohort or case-control analytic studies.

The validity of the fifth and the 10th Body Mass Index percentile as weight cut-offs for anorexia nervosa in adolescence: No evidence from quantitative and network investigation of psychopathology.

OBJECTIVE: Although the fifth Body Mass Index (BMI) percentile is the Diagnostic and Statistic Manual of Mental Disorders -5 weight cut-off criterion to diagnose anorexia nervosa (AN) in children and adolescents, its validity has not been proved, and the 10th percentile value is often applied. We aimed to investigate the diagnostic validity of these weight cut-offs. METHOD: We compared general and eating-disorder (ED) specific psychopathology in 380 adolescents with AN or atypical AN. They were grouped first with respect to the fifth BMI percentile and then with respect to the 10th BMI percentile and differences between groups were analysed. Network analyses on psychopathological symptoms were also conducted. RESULTS: Adolescents with BMI above the fifth and the 10th percentile reported more severe ED specific symptomatology compared to those with BMI below these cut-offs. No significant differences emerged between groups neither in general psychopathology nor in the network structure of psychopathology. CONCLUSIONS: The fifth BMI percentile does not discriminate psychopathology severity in adolescents with AN. From the psychopathology perspective, our findings suggest that adolescents with atypical AN deserve the same clinical and research attention as those with full AN. Future studies are needed to identify a more accurate definition of underweight in adolescents.

Restrictive eating disorders in children and adolescents: a comparison between clinical and psychopathological profiles.

PURPOSE: DSM-5 describe three forms of restrictive and selective eating: Anorexia Nervosa-Restrictive (AN-R), Anorexia Nervosa-Atypical (AN-A), and Avoidant/Restrictive Food Intake Disorder (ARFID). While AN is widely studied, the psychopathological differences among these three diseases are not clear. The aim of this study was to (i) compare the clinical features of AN-R, AN-A, and ARFID, in a clinical sample recruited from a specialized EDs program within a tertiary care children's Hospital; (ii) identifying three specific symptom profiles, to better understand if restrictive ED share a common psychopathological basis. METHODS: Data were collected retrospectively. Psychometric assessment included: the Children's Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Child Behavior Checklist (CBCL), and the Eating Disorder Inventory-3 (EDI-3). RESULTS: A final sample of 346 children and adolescent patients were analyzed: AN-R was the most frequent subtype (55.8%), followed by ARFID (27.2%) and AN-A (17%). Patients with ARFID presented different features from AN-R and AN-A, characterized by lower weight and medical impairment, younger age at onset, and a frequent association with separation anxiety and ADHD symptoms. EDI-3 profiles showed specific different impairment for both AN groups compared to ARFID. However, no differences was detected for items: 'Interpersonal Insecurity', "Interoceptive Deficits", "Emotional Dysregulation", and "Maturity Fears". CONCLUSIONS: Different ED profiles was found for the three groups, but they share the same general psychopathological vulnerability, which could be at the core of EDs in adolescence. LEVEL OF EVIDENCE: III. Evidence obtained from case-control analytic studies.

Radiographic Measurements of the Cardiac Silhouette in Healthy Blue-Fronted Amazon Parrots (Amazona aestiva).

The objective of this investigation was to determine radiographic measurements, without chemical restraint, of the cardiac silhouette in 34 healthy, adult blue-fronted Amazon parrots (Amazona aestiva) of unknown sex with a mean body weight of 393 g. The birds were fasted 3 hours before the radiographic examinations. Three thoracic radiographic views (ventrodorsal, right lateral, and left lateral) were obtained from each bird for assessment. There was no significant statistical difference between right and left radiographic measurements. The mean values of the measurements in the ventrodorsal views were heart width of 21.04 mm and coelomic cavity width of 50.61 mm. The mean values of the measurements in the lateral views were left heart length of 23.44 mm, right heart length of 23.40 mm, left sternal length of 65.69 mm, and right sternal length of 65.03 mm. A strong correlation and ratio of 43% between the heart width and coelomic cavity width and a moderate correlation and ratio of 36% between the heart length and sternal length were observed. In conclusion, the radiographic measurements of the cardiac silhouette in healthy blue-fronted Amazon parrots can be obtained without chemical restraint. The values obtained can be used to assist in the detection of cardiomegaly or microcardia in blue-fronted Amazon parrots.

Controlled impact evaluation of a birth registration intervention, Burkina Faso.

OBJECTIVE: To evaluate the impact of the introduction of secondary civil registration centres on birth registrations within 60 days of birth, in Burkina Faso. METHODS: The faith-based organization Sant'Egidio supported the inauguration of secondary birth registration centres within seven health centres in Réo from July 2015 and four health centres in Godyr from February 2015, at which delivery and vaccination services were available. We calculated the number of timely registrations per 1000 population before and after the launch of the intervention in both the intervention and control municipalities. We used a logistic regression model to evaluate the probability of non-registration as a function of the health centre services used and various demographic and health characteristics, obtained through health registers data and interviews. FINDINGS: Compared with the previous 12 months, the number of timely birth registrations in Réo and Godyr rose from 502 to 2094 (317.1%) and from 267 to 793 (197.0%) during the first 12 months of the intervention. In the two control municipalities, the numbers were unchanged. Infants whose mothers attended health centres for delivery, but did not return for vaccinations, had the lowest proportions of birth registration (69.0%; 294/426; in Réo and 70.2%; 40/57 in Godyr). Infants of mothers who were not interviewed were more likely to not having a timely birth registration (in Réo odds ratio, OR: 6.25; 95% confidence interval, CI: 4.10-9.52 and in Godyr OR: 25.64; 95% CI: 4.31-166.67). CONCLUSION: Introduction of secondary registration centres within health centres increased timely birth registrations.

Re-conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness.

OBJECTIVE: Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa. METHODS: Four-hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory-3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive-compulsive and post-traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters. RESULTS: Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post-traumatic stress problems, drive to thinness, low self-esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self-esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self-esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects. DISCUSSION: These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re-conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.

Are adolescents with anorexia nervosa better at reading minds?

INTRODUCTION: The present study aimed to investigate mindreading abilities in female adolescent patients with AN compared to healthy controls (HCs), analysing differences for emotional valence of facial stimuli. METHODS: The Eating Disorder Inventory) for evaluating psychological traits associated with eating disorders and the Children's version of the Reading the Mind in the Eyes Test for evaluating mindreading abilities were administered to 40 Italian female patients (mean age = 14.93; SD = 1.48) with restrictive diagnosis of anorexia nervosa (AN) and 40 healthy females (mean age = 14.88; SD = 0.56). RESULTS: No significant differences between the AN group and HCs for the Eyes Total score were found. Even when analysing emotional valence of the items, the two groups were equally successful in the facial recognition of positive, negative and neutral emotions. A significant difference was revealed for the percentage of correct responses of item 10 and item 15, where the AN group was less able to correctly identify the target descriptor (Not believing) over the foils than HCs. A significant difference was revealed in discriminating for affective emotions versus cognitive states; only for affective but not for cognitive states, patients with AN were found to perform better than controls on the mindreading task. CONCLUSIONS: Our study highlighted the importance of analysing and discriminating for different valences of facial stimuli when assessing mindreading abilities in adolescents with AN, so that more precise and specific treatment approaches could be developed for female adolescents with AN.

Ultrasonographic evaluation of the liver and gallbladder and hepatic histogram of non-venomous snakes.

This study aimed to describe sonographic features of the liver, gallbladder and hepatic histogram from grey-scale ultrasound in three species of healthy non-venomous snakes. Twenty-eight adult snakes were enrolled in the study, including 10 common boas (Boa constrictor), eight black-tailed pythons (Python molurus) and 10 rainbow boas (Epicrates crassus). The snakes fasted for 30 days and were manually restrained while conscious. For B. constrictor and P. molurus the liver and gallbladder were best visualized in ventral recumbency, and E. crassus in dorsal recumbency. A single elongated hepatic lobe was identified in all snakes. The gallbladder was positioned caudal and separated from the liver, with an oval shape and homogeneous anechoic content in the lumen, and thin and regular walls. A region of interest by pixel number was chosen for the liver, fat bodies, left kidney, and splenopancreas. The mean grey level (G) of the organs had significant differences within each species. Standard deviation of grey levels (SG ) had significant differences within B. constrictor and E. crassus. P. molurus had no significant difference among organs. The comparison among snakes showed that E. crassus had G of liver and splenopancreas lower than B. constrictor and P. molurus. The SG of the liver in E. crassus was lowest compared to B. constrictor and P. molurus. P. molurus showed the highest values in mean of G and SG . In conclusion, despite the liver and gallbladder having similar sonographic features, the grey-level histogram showed that liver echotexture and echogenicity differ among species.

Radiographic and sonographic features, and histogram parameters of the liver and spleen in healthy Toco toucans (Ramphastos toco, Müller 1976).

This study aimed to evaluate radiographic and sonographic features, and histogram parameters based on grayscale ultrasound of the liver and spleen in healthy toco toucans. Fifteen adult toco toucans (Ramphastos toco), seven females and eight males, weighing approximately 650 g, were enrolled in the study. On the right lateral radiographic view, the liver was visualized in the midventral region of the coelomic cavity; ultrasonographically, the liver was located in the middle portion of the coelomic cavity in close relationship to the heart, and thoracic and abdominal air sacs. Two hepatic lobes were identified; the right lobe was larger than the left one. The spleen was visualized in 10 toco toucans on radiographs and only in eight toucans on ultrasound exams. The gallbladder was identified only on ultrasound. On the right lateral radiographic view, the spleen was visualized dorsal to the proventriculus and ventral to the lungs/air sacs as an oval shape. Ultrasonographically, the spleen was observed caudal to the liver, cranial to the proventriculus and craniodorsal to the ventriculus. There was no significant difference in spleen length for either radiographic or ultrasound measurements. The brightness intensity (BI) for mean gray level (G) and standard deviation of gray levels (SG ) in the liver were 101.315 (± 16.170) and 12.453 (± 2.616), respectively. Mean G and SG levels in the spleen were 63.940 (± 18.321) and 7.494 (± 3.595), respectively. In conclusion, the sonographic features and histogram parameters indicated that the liver is more echogenic and heterogeneous than the spleen, which must be considered for diagnosing alterations in these organs.

Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study.

INTRODUCTION: Improving equity in access to services for the treatment of complications that arise during pregnancy and childbirth, namely Emergency Obstetric Care (EmOC), is fundamental if maternal and neonatal mortality are to be reduced. Consequently, there is a growing need to monitor equity in access to EmOC. The objective of this study was to develop a simple questionnaire to measure equity in utilization of EmOC at Wolisso Hospital, Ethiopia and compare the wealth status of EmOC users with women in the general population. METHODS: Women in the Ethiopia 2005 Demographic and Health Survey (DHS) constituted our reference population. We cross-tabulated DHS wealth variables against wealth quintiles. Five variables that differentiated well across quintiles were selected to create a questionnaire that was administered to women at discharge from the maternity from January to August 2010. This was used to identify inequities in utilization of EmOC by comparison with the reference population. RESULTS: 760 women were surveyed. An a posteriori comparison of these 2010 data to the 2011 DHS dataset, indicated that women using EmOC were wealthier and more likely to be urban dwellers. On a scale from 0 (poorest) to 15 (wealthiest), 31% of women in the 2011 DHS sample scored less than 1 compared with 0.7% in the study population. 70% of women accessing EmOC belonged to the richest quintile with only 4% belonging to the poorest two quintiles. Transportation costs seem to play an important role. CONCLUSIONS: We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool.

Comparison of ultrasonographic renal measurements in kittens up to 3 months of age and young cats.

OBJECTIVES: This study aimed to evaluate renal measurements by B-mode ultrasound in kittens during their first 3 months and compare them with those of young adult cats. METHODS: Forty-eight healthy mixed-breed cats (24 males and 24 females) were enrolled in this study. The cats were divided into six age groups: groups 1-5 (kittens) and group 6 (young adult cats). Each kidney was examined using B-mode imaging and the following measurements taken: renal length (RL), renal height (RH), renal width (RW), cortical thickness (CoT), medullary thickness (MdT) and corticomedullary ratio (CMr). The ratio and correlation of RL to aortic diameter (AoD) and the length of the fifth/sixth lumbar vertebrae (LLV) were also determined. RESULTS: Among groups, there was a statistically significant difference between RW, renal volume (RV), CoT, MdT and CMr. The smallest renal dimensions were obtained in the youngest kittens (up to 10 days of age), including RL (1.84 ± 0.40 cm), RH (1.14 ± 0.17 cm), RW (1.25 ± 0.20 cm) and RV (1.47 ± 0.68 ml). A strong correlation was observed between RL:AoD and RL:LLV, allowing for linear regression equations and reference intervals for RL:AoD and RL:LLV to be created for each age group. CONCLUSIONS AND RELEVANCE: B-mode ultrasound showed that renal measurements in kittens differed from those in young adult cats, and that the renal dimensions, renal CoT and CMr increased with the growth of the cat. The RL-LLV ratio is a reliable method for measuring RL according to age group.

Parental Emotional Availability and Family Functioning in Adolescent Anorexia Nervosa Subtypes.

Emotional availability (EA) is a complex construct describing the emotional bond between parents and child, and it refers to support, sensitivity, warmth and closeness. Few studies have investigated the perception of parental EA and its association with dysfunctional eating pattern. The aim of the study is to explore the perception of mothers' and fathers' EA of adolescents with anorexia nervosa (AN) and any differences between the two subtypes of binge-purge (B/P) or restrictive (R) AN. Furthermore, it investigates the association of parental EA with AN symptomatology and with patients' perception of family functioning, which is identified as a maintenance factor for AN. A total of 60 adolescents between 12 and 18 years and their parents (n = 120) were recruited in two eating disorder (ED) specialized care centers. Patients completed the LEAP and the FACES IV questionnaires evaluating parental EA and family functioning, respectively. Results showed no difference between AN subtypes, but a greater perception of mother when compared to father EA was found. Moreover, the EA construct was found not to be associated with ED symptomatology but with a greater positive family functioning. Our study is the first that explores EA in AN, and results suggest the importance of considering parents' emotional engagement as part of the treatment core, together with the eating symptomatology management.

Treating unexplained recurrent pregnancy loss based on lessons learned from obstetric antiphospholipid syndrome and inherited thrombophilia: A propensity-score adjusted retrospective study.

The efficacy of low molecular weight heparin (LMWH) is well-established in patients with obstetric antiphospholipid syndrome (O-APS). Their role in women with unexplained recurrent pregnancy loss (U-RPL) and late obstetrical complications (intrauterine growth restriction, IUGR and preeclampsia) is controversial. Here we compared rates of miscarriage and late obstetrical complications in RPL patients diagnosed with O-APS (n = 57) or hereditary thrombophilia (n = 25) (both assuming LMWH from the beginning of pregnancy) and in patients with a history of U-RPL (n = 118), assuming or not LMWH, followed at the 'Pregnancy at risk' and 'Recurrent pregnancy loss' outpatient clinics at the San Raffaele Hospital from April 2010 to April 2020. Patients with systemic autoimmune diseases other than primary O-APS were excluded. We tested for bivariate or multivariate associations among adverse pregnancy outcomes, the presence of thrombophilia and LMWH use by using chi-square test, Anova, propensity score adjusted univariate logistic regression and multivariate analysis as appropriate. U-RPL patients assuming LMWH from the beginning of pregnancy (group A) had a significantly lower rate of miscarriage compared to U-RPL patients who were not treated with LMWH (group B) (13 % vs. 41 % respectively, p 0.001) and similar pregnancy rates compared to both O-APS patients with a history of RPL taking LMWH (group C, 18 %) and RPL patients with thrombophilia and treated with LMWH (group D, 16 %). Our data highlight a protective effect of LMWH on miscarriage in patients with a history of U-RPL. In these patients, LMWH seems as effective as in O-APS and hereditary thrombophilia in reducing RPL.

Assessing Family Functioning Before and After an Integrated Multidisciplinary Family Treatment for Adolescents With Restrictive Eating Disorders.

The present study presents an investigation of family functioning in the families of adolescents with severe restrictive eating disorders (REDs) assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention, and triadic or family-centered interventions. Nutritional counseling and neuropsychiatric monitoring of the overall treatment and care process were also provided. Family functioning was assessed using the clinical version of the Lausanne Trilogue Play (LTPc), a semi-structured procedure for observing family dynamics, previously validated for this patient population. The LTPc is divided into four phases. In phase 1, the mother interacts with the patient while the father assumes the role of observer. In phase 2, the father plans an activity with the patient while the mother observes. In phase 3, all the family members interact. Finally, in phase 4, the parents talk while the adolescent observes. A significant change emerged in family functioning after the treatment, but only for the interactive phase 2, when the father is required to interact with the daughter while the mother silently observes. The results of this study suggest that a relatively brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, the results also reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.

Coping With Adolescents Affected by Anorexia Nervosa: The Role of Parental Personality Traits.

INTRODUCTION: Anorexia nervosa (AN) promotes psychological distress in caregivers who adopt different coping strategies. Dysfunctional caregiving styles exacerbate further distress in the patient promoting the maintenance of the illness. We aimed to assess the possible contribution of personality traits of caregivers to the adoption of different coping strategies to deal with the affected relative. METHODS: About 87 adolescents with AN were recruited. Their parents completed the Family Coping Questionnaire for Eating Disorders (FCQ-EDs) and the Temperament and Character Inventory-Revised (TCI-R). Differences between mothers and fathers were assessed through the independent sample t-test. Multivariate regression analyses were run to assess if personality traits, the occurrence of psychiatry conditions in the parents, the marital status, and the duration of the illness predicted parental coping strategies. RESULTS: The group of mothers showed higher levels of avoidance and seeking for information coping strategies than the sample of fathers. Lower illness duration predicted higher collusion with the illness in both parents. Harm avoidance, cooperativeness, and self-directedness positively predicted parental coercion, collusion, and seeking for information strategies with some differences between mothers and fathers. DISCUSSION: Illness duration and personality traits of parents affect the type of parental coping strategies developed to face AN in adolescents. These variables should be considered in the assessment of families of adolescents with AN and may be addressed to promote more fine-tuned clinical interventions for caregivers.

Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study.

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.

Ultrasonography of the gastrointestinal tract of toco toucans (Ramphastos toco).

Baseline data for wall thickness in healthy toucans can be used to diagnose disease in sick individuals. This study aimed to evaluate the use of ultrasonography for the examination of the gastrointestinal tract of healthy toco toucans (Ramphastos toco). Ten non-anaesthetized healthy adult toco toucans were evaluated. Food was withheld for 3 h prior to the ultrasound examination. Longitudinal and transverse images of the gastrointestinal tract were obtained using ventromedian cranial and ventromedian caudal approaches to evaluate the morphology and stratification. The wall thickness of the sections was measured: proventriculus and ventriculus, duodenum, jejunum/ileum, and cloaca. Additionally, the thickness of the mucosal layer of the duodenum and jejunum/ileum was also measured. Subsequently, the ratios of the duodenal wall thickness to the duodenal mucosa layer and the total wall thickness of the jejunum/ileum to the jejunum/ileum layer mucosa were stablished. The wall thickness of the proventriculus was significantly higher than the wall thickness of ventriculus. The wall thickness of the duodenum was significantly higher than the wall thickness of jejunum/ileum. The mean ratios of the duodenal wall thickness to the duodenal mucosa layer and the wall thickness of the jejunum/ileum to the jejunum/ileum layer were 83.15% and 80.07%, respectively. In conclusion, it was possible to assess the stomach and intestines using ultrasound examination in healthy toco toucans, due to their medium body size and no interference by surrounding air sacs.

Corrigendum: Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study.

[This corrects the article DOI: 10.3389/fpsyt.2021.653482.].

Low incidence of intrauterine growth restriction in pregnant patients with systemic lupus erythematosus taking hydroxychloroquine.

Systemic lupus erythematosus (SLE) preferentially affects women of childbearing age. Miscarriages or fetal death, intrauterine growth restriction (IUGR), preterm delivery, preeclampsia and disease flares complicate pregnancy in SLE patients. Treatment is challenging due to the need to prevent disease exacerbations and limit obstetrical complications, while showing an acceptable safety profile for both the mother and the fetus. We collected data from 74 pregnancies in 53 SLE patients prospectively followed in a dedicated 'Pregnancy at risk' outpatient clinic from 2003 to 2019. Out of 74, 45 pregnancies patients were treated with hydroxychloroquine (HCQ). Mothers under HCQ therapy (HCQ+ patients) and those who did not receive HCQ (HCQ-) were homogeneous in terms of age and comorbidities. Disease activity prior to conception was slightly higher in HCQ+ patients. No significant difference was observed in terms of obstetrical history. In patients achieving a viable pregnancy, the rate of IUGR (4/39, 10% in HCQ+ vs 8/25, 32%, in HCQ- patients, p < .05) was significantly lower in HCQ+ patients. Conversely, HCQ+ patients displayed a significantly longer time to delivery (37.8 ± 1.72 vs. 36.3 ± 4.11 in HCQ- patients, p < .05). HCQ is safe in pregnant patients with SLE and protects against obstetrical complications.