Bullying Victimization in Children and Adolescents and Its Impact on Academic Outcomes.

ABSTRACT: Bullying victimization has been identified as a significant factor influencing academic outcomes. We sought to evaluate the educational outcomes and psychiatric comorbidities in children and adolescents who are victims of bullying using the National Survey of Children's Health dataset for the study. The participants were children and adolescents (age: 6-17 years) categorized into two groups: group 1, not bullied ( n = 21,015), and group 2, bullied more than once ( n = 21,775). Individuals whose health status was fair or poor have experienced more bullying (2.4% vs . 1.4%, p < 0.001). Individuals in the group 2 were more likely to repeat the grades than the group 1 (7.1% vs . 5.9%, p = 0.039). Individuals who were missing ≥11 school days and sometimes or never engaged in school were observed to be more in the group 2 compared with the group 1 (5.9% vs . 3.2% and 20.3% vs . 10.6%, p < 0.001). In conclusion, bullying victimization could be a risk factor and associated with decreased academic outcomes.

Polymeric black tea polyphenols (PBPs) inhibit benzo(a)pyrene and 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanone-induced lung carcinogenesis potentially through down-regulation of p38 and Akt phosphorylation in A/J mice.

The aim of our study was to evaluate chemopreventive efficacy and possible mechanism of most abundant polyphenolic fraction in black tea, polymeric black tea polyphenols (PBPs), in experimental lung carcinogenesis model. Effect of 1.5% black tea derived PBPs on benzo(a)pyrene [B(a)P] and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) induced lung lesions were studied over 28 wks. Chemopreventive efficacy was studied using decrease in tumor incidence and/or multiplicity and/or delay in the latency period in A/J mice. Histopathological analysis of lung was carried out post-carcinogen treatment weeks to analyze the microscopic lung lesions. Inflammation, cell proliferation, and apoptosis markers along with signaling kinases like p38, Akt, and their phosphorylated forms were studied using immunoblotting and immunohistochemistry at 4th, 10th, and 18th wk post-carcinogen treatment. Administration of PBPs throughout the treatment period significantly decreased the multiplicity of surface tumors as well as microscopic lung lesions, including adenomas. Although tumor incidence and latency period remains unaffected, histopathological evaluation of lung at 6, 10, and 18 wks post- carcinogen treatment period showed decrease in tumor multiplicity which was also correlated with different molecular markers. Anti- inflammatory action of PBPs was demonstrated by reduced Cox-2 expression. PBPs down-regulated the B(a)P and NNK-induced cell proliferation (diminished PCNA expression, proliferation index, and Bcl-2 expression) and enhanced apoptosis (increased Bax expression and apoptotic index) potentially through phosphorylation of p38 and Akt. PBPs, most abundant polyphenolic component in the black tea, have chemopreventive effect through inhibition of inflammation, cellular proliferation, and induction of apoptosis possibly via modulation of signaling kinases. © 2016 Wiley Periodicals, Inc.

Primary non-metastatic Ewing sarcoma of the jaw in children: results of surgical resection and primary reconstruction.

BACKGROUND AND OBJECTIVE: The rarity of Ewing sarcoma (ES) of the jaw coupled with the technical challenge of resection and associated functional and cosmetic impairment has resulted in deficient data on surgical management of these tumors. The purpose of this study is to describe the results of surgical excision and reconstruction of primary non-metastatic ES of the mandible and maxilla in children. METHODS: Consecutive patients (mandible = 6, maxilla = 5) treated with surgery from August 2005 to January 2013 were selected. All patients received induction chemotherapy and were selected for surgical resection based on the presence of specific criteria for operability. RESULTS: The median age was 11.5 years (range 5-16 years). Free fibular osteocutaneous flap was commonly used for reconstruction. There were no complications related to microvascular anastomosis or flap loss. Five patients had 100% tumor necrosis and did not receive radiotherapy. Teeth alignment, chewing, swallowing, and speech were normal in all and donor site morbidity occurred in one. The 5-year overall, event-free survival, and local control are 87.5%, 72.9%, and 90%, respectively. CONCLUSION: In eligible patients, surgery with contemporary reconstruction results in optimal oncological and functional outcome. Surgery also has the added advantage of identifying patients who may not need radiotherapy.

Pulmonary adenofibroma: clinicopathological study of 3 cases of a rare benign lung lesion and review of the literature.

Pulmonary adenofibroma is a rare benign biphasic tumor of the lung composed of epithelial and stromal components. We report 3 cases of this unusual lesion of lung in a male (25 years old) and 2 female (40 and 55 years old) patients. Breathlessness on exertion and mild left-sided chest pain of 1 month's duration were the main concerns in 2 patients, whereas the third had cough and hemoptysis for 3 months. Chest radiograph and computed tomography scan revealed a well-circumscribed, subpleural homogenous mass in left lower chest fields in 2 cases and solid-cystic lesion in left upper lobe in the third patient. All 3 patients underwent lobectomy, following biopsy in 2 cases. Histology revealed a well-circumscribed lesion composed of complex glandlike spaces lined by cuboidal to columnar epithelium surrounded by a hyalinized spindle-cell fibroblastic proliferation reminiscent of adenofibroma of the female genital tract or fibroadenoma of the breast. Immunohistochemical examination supported the diagnosis of a benign pulmonary adenofibroma. All 3 patients were are alive and doing well with no evidence of recurrent or metastatic disease. Diagnosis on biopsy can be challenging and may be misinterpreted as well-differentiated adenocarcinoma with extensive fibrosis or low-grade sarcoma. Frozen-section consultation will be a valuable adjunct in planning for limited lung resection of this benign lung lesion. Although we described 3 cases of pulmonary adenofibroma, still this is the largest published series of this rare entity till date. The possible histogenesis and various differential diagnoses are discussed along with literature review.

Outcome and morbidity of surgical resection of primary cervical and cervicothoracic neuroblastoma in children: a comparative analysis.

INTRODUCTION: Primary cervical (CN) and cervicothoracic neuroblastoma (CTN) is generally associated with good outcome; however, surgical resection can be challenging and not without morbidity. The aim of this study is to assess the overall outcome and compare the clinico-radiological features, treatment, and complications of CN and CTN. MATERIALS AND METHODS: Sixteen consecutive patients, (CN = 9, CTN = 7) treated between November 2006 and December 2012 were selected from the prospective database for this analysis. RESULTS: The 2-year overall and event-free survival of entire cohort is 100 and 72 %, respectively. Respiratory symptoms due to compression of airway and intraspinal extension were common in CTN. Gross total resection was feasible in all patients with CN; in contrast, incomplete excision along with significantly longer duration of surgery and more blood loss occurred in CTN. Postoperative morbidity was seen in three patients with CN and only one patient with CTN. The extent of surgery did not affect the overall and event-free survival of CTN (p = NS). CONCLUSION: CN and CTN have characteristic clinico-radiological presentation and surgical specification. However, both have a favorable outcome, even though with a distinct but acceptable morbidity. The favorable outcome in CTN is unrelated to the extent of surgical excision.

Chemotherapy compliance in patients with osteosarcoma.

PURPOSE: Histological response (HR) to neoadjuvant-chemotherapy (NACT) is considered as a robust prognostic marker in treated osteosarcomas. Chemotherapy compliance can affect both, dose intensity and density and may affect the final outcome in these cases. This vital aspect has been inadequately addressed and therefore merits further investigation. METHOD: A retrospective study of NACT-treated osteosarcoma patients, during the year 2010 was conducted. Compliance was defined as receipt of planned cycles of chemotherapy in the planned doses, within the planned duration or up to 25% additional time. HR was assessed by grading for histological necrosis (HN). Good responders (GR) included those with tumors showing ≥90% HN. RESULTS: Of 124 patients, 115 were analyzed for post-NACT HR. Of the 73 (64%) compliant patients, 47 were GR and of the 42 (36%) non-compliant patients, 18 were GR. There was significant association between GR and compliance (P = 0.031). However, at a median follow-up of 7.9 months, there was no significant difference in survival between the noncompliant versus compliant group. Non-compliance was justifiable in 26 patients and not justifiable in 16 patients. Using univariate analysis, T-size, pain, performance status, albumin, LDH, and education were identified as significant factors, while in multivariate analysis, only poor performance status was identified as an independent variable for non-compliance. CONCLUSIONS: Two-thirds patients were found to be compliant with NACT. There was a significant association between GR and compliant patients. Significant correlation between compliance and survival may be established with a longer follow-up particularly since "good necrosis" is generally predictive of good survival.

Extraskeletal Ewing sarcoma in children and adolescents: impact of narrow but negative surgical margin.

PURPOSE: The aim of the study was to determine the impact of negative but close resection margins on local recurrence in children with extraskeletal Ewing sarcoma (EES). METHOD: We reviewed records of 32 patients with EES treated between March 2005 and March 2013. All patients except one underwent surgical excision either upfront or after induction chemotherapy. Patients with viable tumor and negative surgical margins, which were categorized as less than or greater than 1 cm, were selected. Local control and survival analysis were performed for patients in both the groups. RESULTS: The 5-year event-free and overall survival rates of entire cohort is 68 and 77 %, respectively. Surgical margins were negative in 23/26 (90.3 %) patients. There were no local recurrences in any of the patients with margins of less than 1 cm. Only one patient with a margin greater than 1 cm had a local recurrence along with distant metastases. A tumor-free margin of more than 1 cm did not affect overall or event-free survival (p = NS). CONCLUSION: Optimal local control is feasible in children with EES regardless of the quantitative extent of negative margins. Achieving a three-dimensional tumor-free margin should be the goal of surgical resection.

Role of Psychosomatic Symptoms in COVID-19 Vaccine Hesitancy.

Vaccination against COVID-19 is one of the highly effective preventative strategies to reduce morbidity and mortality associated with COVID-19 infection. The rapid approval of COVID-19 vaccination due to the raging pandemic, media coverage, anti-vaccination groups, and concerns about adverse effects associated with vaccination has given rise to COVID-19 vaccine hesitancy. Current evidence suggests that psychosomatic and nocebo-related adverse effects account for a significant proportion of common adverse effects following COVID-19 vaccination. The most common adverse effects are headache, fatigue, and myalgia, which are highly prone to nocebo effects. In our review article, we discuss the role of psychosomatic and nocebo effects in COVID-19 vaccination-related hesitancy, predictors of such effects, and strategies to reduce vaccine hesitancy. General education regarding psychosomatic and nocebo effects and specialized education for at-risk populations may reduce psychosomatic and nocebo-related adverse effects following COVID-19 vaccination, ultimately reducing hesitancy.

Effectiveness of Repetitive Transcranial Magnetic Stimulation in Depression, Schizophrenia, and Obsessive-Compulsive Disorder: An Umbrella Meta-Analysis.

Objective: To analyze the safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder, schizophrenia, and obsessive-compulsive disorder (OCD) via umbrella meta-analysis.Data Sources: Meta-analysis studies were searched in PubMed from inception to May 2021 using the keywords anxiety, depression, ADHD, schizophrenia, mood disorder, OCD, psychiatric disorders, GAD, bipolar disorders, ASD, PTSD, transcranial magnetic stimulation, transcranial, magnetic, stimulation. PRISMA guidelines were followed.Study Selection: Abstracts and full-length articles were reviewed for meta-analysis studies with data on the safety and efficacy of rTMS and sham and were collected for quantitative analysis. The full texts of all identified studies were independently screened and assessed to determine eligibility. Any disagreement was resolved through consensus.Data Extraction: The descriptive variables extracted included the author names, study year, sample size, studies included in the meta-analysis, study period, and type of intervention.Results: 28 meta-analyses were included; 13 were on treatment-resistant depression, 9 on schizophrenia, and 6 on OCD. In treatment-resistant depression, the rTMS group had higher odds of response compared to sham (odds ratio [OR] = 3.27; 95% CI, 2.76-3.87; P < .00001) and higher odds of remission (secondary outcome) (OR = 2.83; 95% CI, 2.33-3.45; P < .00001). rTMS was superior to sham in the reduction of negative symptoms of schizophrenia (mean difference [MD]: 0.47; 95% CI, 0.23-0.7; P < .0001). However, no significant difference was found between the effects of rTMS and sham on auditory hallucinations (MD: 0.24; 95% CI, 0.26-0.74; P = .35), which resulted in 94% heterogeneity. TMS was better than sham in reducing the severity of OCD symptoms (MD: 0.81; 95% CI, 0.53-1.10; P < .00001).Conclusions: The effectiveness of rTMS for symptom reduction in various psychiatric disorders is associated with differences in neuropathology, disease-specific target site, and frequency of rTMS.Prim Care Companion CNS Disord 2023;25(5):22r03423. Author affiliations are listed at the end of this article.

Tumor and local lymphoid tissue interaction determines prognosis in high-grade serous ovarian cancer.

Tertiary lymphoid structure (TLS) is associated with prognosis in copy-number-driven tumors, including high-grade serous ovarian cancer (HGSOC), although the function of TLS and its interaction with copy-number alterations in HGSOC are not fully understood. In the current study, we confirm that TLS-high HGSOC patients show significantly better progression-free survival (PFS). We show that the presence of TLS in HGSOC tumors is associated with B cell maturation and cytotoxic tumor-specific T cell activation and proliferation. In addition, the copy-number loss of IL15 and CXCL10 may limit TLS formation in HGSOC; a list of genes that may dysregulate TLS function is also proposed. Last, a radiomics-based signature is developed to predict the presence of TLS, which independently predicts PFS in both HGSOC patients and immune checkpoint inhibitor (ICI)-treated non-small cell lung cancer (NSCLC) patients. Overall, we reveal that TLS coordinates intratumoral B cell and T cell response to HGSOC tumor, while the cancer genome evolves to counteract TLS formation and function.

Osteosarcoma of the femur mimicking Ewing sarcoma/primitive neuroectodermal tumour on biopsy and metastatic carcinoma on resection.

Osteosarcoma (OS) is known to have several morphological appearances, small cell osteosarcoma and epithelioid osteosarcoma being two well recognized patterns. The former can be mistaken for a Ewing sarcoma/primitive neuroectodermal tumour (ES/PNET), whereas the latter mimics metastatic carcinoma. Herein we present an osteosarcoma in a 17-year-old girl that was diagnosed as an ES/PNET on biopsy; however, the resected specimen revealed a very unusual morphology mimicking a metastatic carcinoma with a sex cord stromal tumour-like pattern.

Sudden cardiac death: look closely at the coronaries for spontaneous dissection which can be missed. A study of 9 cases.

Spontaneous coronary artery dissection is a rare cause of death seen largely in young women, with many cases occurring in the early postpartum period. Nine cases with this condition were examined from our histopathology records comprising 6 women and 3 men with an age range of 26 to 47 years. All deaths were sudden, and only one patient complained of chest pain and she was 8 weeks postpartum. All cases showed dissection macroscopically, though 4 of the 6 cases, which were sent for a second opinion, were described as having normal coronaries by the referring pathologists. One heart seemed to have postmortem coronary artery thrombus and dissection was difficult to discern on gross examination. All cases were examined histologically and confirmed acute dissection of the coronary arteries, with more than 2 arteries affected in 2 cases. Histologic features of myocardial ischemia/infarction were noted in 4 cases so the explanation for the sudden death in the other 4 cases remains a possible fatal arrhythmia. The macroscopic changes in the heart of acute coronary artery dissection can be difficult to detect and can be easily mistaken for postmortem clot or a thrombus overlying an atheromatous plaque. All such cases with thrombus in the arteries, even the normal-looking coronary arteries, in young adults should be examined microscopically for dissection

A Case of Serotonin Syndrome Precipitated by Quetiapine in a Middle-Aged Female on Trazodone and Sertraline.

Serotonin syndrome (SS) is a potentially life-threatening condition caused by drugs that act on serotonergic receptors or alter serotonin metabolism. We present a case of SS in a middle-aged female who was taking trazodone and sertraline as her home medications and developed SS after being started on quetiapine during her hospital course. A 54-year-old female with a past medical history of dementia and bipolar disorder was brought to the emergency department from a nursing home for altered mental status. Delirium was ruled out. Initial blood work was significant for an elevated creatine phosphokinase (CPK) level of 753 U/L. She was started on Quetiapine 100 mg bis in die (BID) after admission as she had a history of bipolar disorder and she was having acute mood symptoms (impulsive, irritable, confrontational, belligerent, and unable to be redirected). On the second day of admission, the patient started having diaphoresis, tremors, hyperreflexia, myoclonus, and ocular clonus. A diagnosis of SS was made using Hunter's criteria. All serotonergic medications were discontinued after which the patient started improving. She was also started on supportive therapy including IV fluids, lorazepam, and cyproheptadine. The patient was discharged on the fourth day of admission.

Hopelessness, Suicidality, and Co-Occurring Substance Use among Adolescent Hallucinogen Users-A National Survey Study.

(1) Objectives: Hallucinogens are being explored as a potential treatment of psychiatric disorders. Micro dosing of illicitly purchased hallucinogen drugs is on the rise despite conclusive benefits. We aimed to evaluate the prevalence and odds of hopelessness, suicidality, and co-occurring substance use among adolescent hallucinogen users. (2) Methods: We performed a retrospective analysis of the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System (YRBSS) 2001−2019 data that nationally represents school-going US adolescents. We identified hallucinogen use based on the survey questions, exploring the use of hallucinogens (LSD, PCP, mescaline, and mushrooms). (3) Results: Out of a total of 125,550 respondents, 8.4% reported using hallucinogens. Overall, the trend of hallucinogen use decreased from 13.3% (2001) to 7.0% (2019) (pTrend < 0.0001). Hallucinogen users were at high odds of feeling sad and hopeless (aOR: 1.40; 95%CI: 1.21−1.61; p < 0.0001), considering suicide (aOR: 1.36; 95%CI: 1.08−1.70; p = 0.009), and planning suicide (aOR: 1.49; 95%CI: 1.19−1.86; p = 0.001). Additionally, adolescent hallucinogen users had a higher prevalence of alcohol, cigarette, e-cigarette, marijuana, synthetic marijuana, inhalants, heroin, cocaine, methamphetamine, and ecstasy use. (4) Conclusions: The overall trend of hallucinogen use decreased among school-going American adolescents. We found a high prevalence of co-occurring substance use among hallucinogen users. We found that hallucinogen users were at high odds of feeling sad, hopeless, and considering and planning suicide. Further research is needed to explore the effects of recreational hallucinogen use among the adolescent population.

Adderall-Induced Persistent Psychotic Disorder Managed With Long-Acting Injectable Haloperidol Decanoate.

Adderall is one of the most commonly prescribed stimulant medications for attention deficit hyperactivity disorder (ADHD). Although safe and effective when clinically indicated at the appropriate dose, stimulant misuse may lead to serious adverse effects. We report a 29-year-old male with a diagnosis of ADHD who took more than the recommended therapeutic dose of Adderall prescribed by his psychiatrist. He subsequently presented with persistent psychotic symptoms, which responded to oral haloperidol. Due to treatment non-compliance with multiple recurring psychiatric hospitalizations, long-acting injectable haloperidol decanoate was considered to improve compliance and prognosis. The patient's psychosis remained in remission while on the long-acting injectable. In this case study, we highlight the need for future research to identify stimulant misuse risk factors. Randomized clinical trials are needed to determine the effectiveness of long-acting injectable antipsychotic medication in the management of persistent psychosis secondary to stimulant misuse.

Burden of Psychiatric Disorders in Moyamoya Disease: A National Inpatient Perspective From 2007-2014.

Objective: Moyamoya disease is a cerebrovascular illness that causes progressive stenosis of the intracranial internal carotid arteries and their proximal branches, increasing the risk of stroke. Moyamoya disease is associated with a small number of neuropsychiatric symptoms. The objective of this study was to investigate psychiatric comorbidities and trends in patients with Moyamoya disease in the United States.Methods: US National Inpatient Sample data from 2007 to 2014 were used for analyses in this cross-sectional study. The frequency of psychiatric and nonpsychiatric disorders among adult patients with known Moyamoya disease was assessed. Baseline demographics included in the analysis and diagnostic codes used to identify psychiatric disorders were determined. Categorical and continuous data were assessed using Pearson χ2 test and Mann-Whitney U test, respectively. All analyses were conducted using SPSS version 22.0.Results: The prevalence of psychiatric comorbidities was 38.7% (7,861/20,289). The most common psychiatric disorders were mood disorders (17.8%) and anxiety disorders (8%). Psychosis and drug abuse were present in 4.4% and 4.1% of patients, respectively. Approximately 1 in 4 patients (22.2%) with Moyamoya disease had previously been screened for mental health or substance abuse. The rate of suicide or self-inflicted injury was 0.8%.Conclusions: The impact of Moyamoya disease on mental health services is expected to grow, as the condition's prevalence is increasing at a rate of approximately 1.5- to 2-fold. A multidisciplinary approach between neurology, psychiatry, and primary care can improve screening and management of comorbid psychiatric disorders.

Mental health disparities amongst sexual-minority adolescents of the US - A national survey study of YRBSS-CDC.

OBJECTIVE: We aimed to evaluate the prevalence and trend of identifying as a sexual minority among the American adolescent population. Additionally, we aimed to evaluate the prevalence and odds of substance abuse, hopelessness, and suicidality among the sexual minority adolescents compared to their heterosexual peers. METHODS: We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data from 2015 to 2019. YRBSS divides "Sexual identity" into three groups: heterosexuals, sexual minorities (gay or lesbian or bisexual), and unsure. We identified "hopelessness and suicidality" using the survey questions exploring if participants felt sad or hopeless for >2 weeks, considered suicide, made a suicide plan, and attempted suicide requiring medical care. Univariate and multivariable survey logistic regression analyses were performed to establish an association between hopelessness, suicidality, substance abuse, and identifying as a sexual minority. RESULTS: Out of 41,377 adolescents, 4055 (9.8%) identified as a sexual minority. An increasing percentage of adolescents identified themselves as a sexual minority between 2015 to 2019 (8% to 11.2%) (pTrend<0.0001). The sexual minority had a higher prevalence of feeling sad and hopeless (63.4 vs. 28.6%), considering suicide (46 vs. 14.2%), planning suicide (38.9 vs. 11.5%), attempting suicide, and having injurious suicide attempts compared to heterosexuals. (p<0.0001) Amongst sexual minorities, the prevalence of substance abuse was higher compared to their heterosexual peers, which includes cigarettes (15 vs 7.8%), e-cigarette (27.2 vs 23.2%), inhalants (14.1 vs 5.3%), cocaine (8.4 vs 3.9%), marijuana (31.2 vs 20.2%), alcohol (36.9 vs 30.3%), steroids (6.4 vs 2.2%), heroin (4.4 vs 1.2%), and injectable drugs (4.0 vs 1.1%) (p<0.0001). In regression analysis, the sexual minority had higher odds of substance abuse, feeling sad and hopeless (aOR:4.6; 95%CI:4.0-5.2; p<0.0001), considering suicide (3.2; 2.8-3.7; p<0.0001), planning suicide (2.0; 1.7-2.3; p<0.0001) compared to heterosexual. CONCLUSION: Sexual minorities not only have higher prevalence and odds of hopelessness and suicidality but also have higher prevalence and odds of substance abuse like cigarettes, marijuana, cocaine, heroin, inhalants, and steroids. Hence, early identification, risk stratification, and interventions to reduce mental health disparities are needed.

Depression in Childhood Asthma vs. Adult-Onset Asthma: A Cross-Sectional Study from the National Health and Nutrition Examination Survey (NHANES).

Background: asthma, a chronic respiratory disease caused by inflammation and narrowing of the small airways in the lungs, is the most common chronic childhood disease. Prevalence of childhood asthma in the United States is 5.8%. In boys, prevalence is 5.7% and it is 6% in girls. Asthma is associated with other comorbidities such as major depressive disorder and anxiety disorder. This study explores the association between asthma and depression. Methods: we conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. Asthma and childhood onset asthma were assessed using questionnaires MCQ010 and MCQ025, respectively. Sociodemographic variables were summarized, and univariate analysis was performed to determine the association between asthma and major depressive disorder and its individual symptoms. Results: there were 402,167 participants from 2013−2018 in our study: no asthma in 84.70%; asthma in 15.30%. Childhood onset asthma (COA) included 10.51% and adult-onset asthma (AOA) included 4.79%. Median age of COA is 5 years and AOA is 41 years. Among the asthma groups, most AOA were females (67.77%, p < 0.0001), most COA were males (52.16%, p < 0.0001), and ethnicity was predominantly White in AOA (42.39%, p < 0001) and in COA (35.24%, p < 0.0001). AOA mostly had annual household income from $0−24,999 (35.91%, p < 0.0001), while COA mostly had annual household income from $25,000−64,999 (36.66%, p < 0.0001). There was a significantly higher prevalence of MDD in COA (38.90%) and AOA (47.30%) compared to NOA (31.91%). Frequency of symptoms related to MDD were found to have a significantly higher prevalence and severity in the asthma groups compared to no asthma, and slightly greater and more severe in AOA than in COA. Symptoms include having little interest in doing things (COA 18.38% vs. AOA 22.50% vs. NOA 15.44%), feeling down, depressed, or hopeless (COA 20.05% vs. AOA 22.77% vs. NOA 15.85%), having trouble sleeping or sleeping too much (COA 27.38% vs. AOA 23.15% vs. NOA 22.24%), feeling tired or having little energy (COA 39.17% vs. AOA 34.24% vs. NOA 33.97%), having poor appetite or overeating (COA 19.88% vs. AOA 20.02% vs. NOA 15.11%), feeling bad about yourself (COA 13.90% vs. AOA 13.79% vs. NOA 10.78%), having trouble concentrating on things (COA 12.34% vs. AOA 14.41% vs. NOA 10.06%), moving or speaking slowly or too fast (COA 8.59% vs. AOA 9.72% vs. NOA 6.09%), thinking you would be better off dead (COA 3.12% vs. AOA 4.38% vs. NOA 1.95%) and having the difficulties these problems have caused (COA 21.66% vs. AOA 26.73% vs. NOA 19.34%, p < 0.0001). Conclusion: MDD and related symptoms were significantly higher and more severe in participants with asthma compared to no asthma. Between adult-onset asthma compared to childhood onset asthma, adult-onset asthma had slightly greater and more severe MDD and related symptoms compared to childhood onset asthma.

Rhinosporidiosis isolated to the distal clavicle: a rare presentation clinicoradiologically mimicking a bone tumor.

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, which commonly affects young men and predominantly involves the mucous membranes of the nose, nasopharynx and eyes. Involvement of extranasal sites including bone has been reported, but rarely. We present a case of a 32-year-old farmer, who presented with a non-tender, fixed swelling over his right shoulder. Radiography and CT imaging showed an expansile, lytic, destructive lesion involving the lateral end of the right clavicle with soft tissue extension. The clinicoradiological impression was that of a primary bone tumor. Biopsy and wide excision of the lesion revealed features of rhinosporidiosis. There were no mucocutaneous lesions. Involvement of bone without associated mucocutaneous lesions is exceedingly rare in rhinosporidiosis. Involvement of the clavicle, as seen in the present case, has not been reported in the English language-peer reviewed literature, to the best of our knowledge.

Melanotic neuroectodermal tumor of infancy in thigh of an infant--a rare case report with diagnostic implications.

Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon tumor of neural crest origin, almost invariably identified in the head and neck region. It is a relatively benign tumor but can recur and rarely metastasize. Herein, a rare case of MNTI in the thigh of an infant is documented. Radiographic imaging showed a sclerotic and lytic lesion in the metadiaphyseal region of the right femur with a soft tissue component. The clinicoradiological impression was of a malignant round cell tumor and osteomyelitis. The patient's urinary vanil mandelic acid (VMA) level was elevated. FNAC smears revealed a tumor with round to polygonal cells, focally containing black melanin pigment. Biopsy and tumor excision revealed a tumor with cells in cords and nests embedded in a fibrocollagenous stroma and showed bone and soft tissue infiltration. On immunohistochemistry, tumor cells displayed immunoreactivity to vimentin, cytokeratin (CK), CK7, CK19, and MIC2, and focal reactivity for synaptophysin and HMB45. Diagnosis of an MNTI was made. The patient underwent induction chemotherapy with extracorporeal radiotherapy, followed by a soft tissue excision that revealed residual tumor. Surgically, free marrow margins were accomplished, and the patient is currently being followed-up. To the best of our knowledge this case is the fifth documented case in the English literature of MNTI in the thigh. The diagnostic and therapeutic implications are discussed.