Clinical and socio-demographic features in childhood vs adolescent-onset anorexia nervosa in an Asian population.

PURPOSE: Childhood-onset anorexia nervosa (AN) may be under-recognised and under-treated due to atypical presentations. The aims of this study are: (1) describe features of AN in patients ≤ 18 years in an Asian population; and (2) compare childhood-onset and adolescent-onset AN. METHODS: This study involved a retrospective chart review of patients ≤ 18 years in a Asian population who were treated for anorexia nervosa at the Eating Disorders Service at Singapore General Hospital between Jan 2003 and Dec 2014 (n = 435). Childhood-onset AN was defined as onset < 13 years, while adolescent-onset AN was defined as onset between 13 and 18 years. RESULTS: Patients were predominantly female (95.4%) and Chinese (83%). The childhood-onset group (8.3%) had mean age of onset 11.5 ± 1.0 years, compared to 15.2 ± 1.6 years for the adolescent-onset group. The childhood and adolescent-onset groups were similar in socio-demographic variables, as well as gender distribution, AN subtype, number of psychiatric comorbidities, family history of psychiatric illness, body image issues and excessive exercise. The childhood-onset group had significantly longer duration of illness prior to presentation (4.75 vs 2.62 years), greater frequency of comorbid obsessive-compulsive disorder (19.4% vs 5.3%) and were more likely to report teasing as a trigger for AN (58.3% vs 31.6%). The childhood-onset group had significantly longer duration of inpatient stay (5.97 vs 3.22 weeks), as well as a greater number of total admissions (2.78 vs 1.37). CONCLUSION: Our results suggest that cultural factors may impact the development or identification of AN in an Asian context. Possible delay in diagnosis of childhood-onset AN may lead to a more unfavorable clinical course. LEVEL OF EVIDENCE: Level V, descriptive study.

Internet and smartphone application usage in eating disorders: A descriptive study in Singapore.

Eating disorders are associated with significant morbidity and mortality. The Internet is a popular medium for individuals with eating disorders to discuss and reinforce their affliction. However, the available literature on Internet usage and eating disorders is scarce, especially in the area of social media and smartphone application ("app") usage. This study looked at the Internet and smartphone app usage patterns of participants who presented with an eating disorder in Singapore, and whether it corresponded to severity of illness. Individuals who presented to the Eating Disorders clinic at the Singapore General Hospital completed a self-reported questionnaire on Internet and app usage. They also completed the EDE-Q, EAT-26 and CIA 3.0. 55 participants completed the study. 41.8% had anorexia nervosa, 34.5% had bulimia nervosa, and 9.1% were ED-NOS. 41.8% felt that apps helped to perpetuate their illness while 32.7% felt that the apps were helpful for recovery. Overall, any smartphone application usage was associated with younger age and greater eating disorder psychopathology and psychosocial impairment. While 30.9% had encountered eating disorder-related content on Facebook, only 12.7% visited Facebook groups related to eating disorders. For YouTube, "Cooking and Food" and "Beauty and Fashion" videos were among the top 3 types of videos that participants watched. In conclusion, Internet and smartphone app usage is significant, and they are associated with greater severity of illness. It is necessary to include interventions in this aspect as part of treatment of eating disorders.

Transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy) as a complication of permanent pacemaker implantation.

BACKGROUND: Takotsubo cardiomyopathy is a rare and newly described clinical entity characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis in the absence of angiographic evidence of significant coronary vessel disease found predominantly in post-menopausal women. It was first documented in the USA in 2004, and it has previously been described only in Japanese and Caucasian patients. CASE REPORT: A 77-year-old Native Hawaiian woman was admitted to the hospital for severe bradycardia. To the best of our knowledge, this is the first time that normal ventricular function has been documented by echocardiography just prior to the development of the syndrome of transient left ventricular apical ballooning. METHODS: Retrospective review of the reported patient's medical record, cardiac angiography and ventriculography, echocardiography, and ECGs. DISCUSSION: The patient reported manifested all of the diagnostic criteria for transient left ventricular apical ballooning syndrome proposed by the Mayo Clinic. The finding of normal cardiac morphology and contractility by echocardiography two days prior to diagnosis shows that this syndrome develops rapidly. The case reported here is the first time that transient left ventricular apical ballooning syndrome has been documented in a Native Hawaiian patient in a tropical location, suggesting that transient left ventricular apical ballooning likely occurs across all ethnic and geographical lines.