Primary De novo ductal adenocarcinoma of the lacrimal gland.

BACKGROUND: Primary ductal adenocarcinoma of the lacrimal gland is a rare and aggressive malignant epithelial lacrimal gland neoplasm, morphologically and phenotypically resembles salivary duct carcinoma, and both strongly resemble infiltrating ductal carcinoma of breast. METHOD: Retrospective Chart review of cases of malignant lacrimal gland tumors from 2013 July to 2020 July. Authors describe the clinico radiological, morphological and immunohistochemical features of primary ductal adenocarcinoma (PDA) of lacrimal gland. Extensive review of literature of PDA of lacrimal gland and salivary gland ductal carcinoma has been performed. RESULTS: Retrospective chart review of the last 7 years yielded 22 malignant lacrimal gland neoplasms of which 4 cases demonstrated features of primary ductal adenocarcinoma of lacrimal gland, 2/4 cases showed an evidence of a pre existing pleomorphic adenoma and 2 were found to be de novo ductal adenocarcinomas. PDA of lacrimal gland showed expression of CK7, CK19, AR, HER2, cyclin D1 and were negative for CK5/14, CK 20, ER, PR, PSA, TTF-1, S-100 and SMA. Expression of GCDFP-15 was noted in one case. The presence of multiple events of loco-regional recurrences and/or distant metastasis necessitated a multidisciplinary approach. CONCLUSIONS: Authors have expressed the need of clinical correlation; thorough tissue sampling and extensive immunohistochemical work up in identification of de novo PDA's and their molecular subtypes. A multi-institutional study might help in formulating the diagnostic criteria, identification of actionable targets, and thus study the role of targeted therapy in this rare and aggressive tumor which may result in better patient outcomes.

Self-Inflicted Gun Violence Injuries Epidemic in the United States: A Closer Look at the Nation's Well-Being.

Gun-related injuries are a hotly debated sociopolitical topic in the United States. Annually, more than 33 million Americans seek heathcare services for mental health issues. These conditions are the leading cause of combined disability and death among women and the second highest among men. Our study's main objective was to identify cases of self-inflicted penetrating firearm injuries with reported pre-existing psychiatric conditions as defined in the 2013-2016 National Trauma Data Standard. The 2013-2016 Research Data Sets (RDSs) were reviewed. Cases were identified using the ICD-9 external cause codes 955-955.4, and ICD 10th Edition Clinical Modification external cause codes X72-X74. Odds ratios were calculated, and categorical data were analyzed by using the chi-squared test, with significance defined as P < 0.05. The 2013-2016 Research Data Set consists of 3,577,168 reported cases, with 15,535 observations of self-inflicted penetrating firearms injuries. Of those patients, 18.4 per cent had major psychiatric illnesses, 7.5 per cent had alcohol use disorder, 6.4 per cent had drug use disorder, and 0.6 per cent had dementia. An upward trend in the proportion of patients with major psychiatric illnesses was observed, from 15.5 per cent in 2013 to 18.6 per cent in 2016, peaking in 2015 at 20.9 per cent. Nearly one in three self-inflicted penetrating firearm injuries in the United States is associated with pre-existing behavioral health conditions. Advances in understanding the behavioral and social determinants leading to these conditions, and strategies to improve the diagnosis of mental illness and access to mental health care are required.

Physical activity, sedentary behavior and development of preeclampsia in women with preexisting diabetes.

AIMS: To explore the association between physical activity in early pregnancy and development of preeclampsia in women with preexisting diabetes. METHODS: In a prospective cohort study of 189 women with preexisting diabetes (110 type 1 and 79 type 2 diabetes), physical activity during pregnancy including sedentary behavior was evaluated with the Pregnancy Physical Activity Questionnaire. Primary outcome was preeclampsia. Secondary outcomes were preterm delivery, large and small for gestational age infants. RESULTS: Women developing preeclampsia (n = 23) had higher diastolic blood pressure in early pregnancy (mean 82 ± 9 SD vs. 77 ± 8, p = 0.004) and were more often nulliparous (91 vs. 52%, p < 0.001) compared with the remaining women (n = 166). Total physical activity in early pregnancy was similar between the groups (median 148 metabolic equivalent of task hours per week (MET-h/week) (interquartile range 118-227) versus 153 (121-205), p = 0.97). In early pregnancy, women developing preeclampsia reported a higher level of sedentary behavior (15 MET-h/week (7-18) versus 7 (4-15); p = 0.04); however, when adjusting for parity, diastolic blood pressure and smoking, the association attenuated (p = 0.13). Total physical activity and sedentary behavior in early pregnancy were not associated with preterm delivery, large or small for gestational age infants. CONCLUSIONS: Among women with diabetes, sedentary behavior was reported higher in early pregnancy in women developing preeclampsia compared with the remaining women, while total physical activity was similar. Sedentary behavior was a predictor of preeclampsia in the univariate analysis, but not in the multiple regression analysis, and larger studies are needed to evaluate this possible modifiable risk factor. Trial registration The study was registered at ClinicalTrials.gov (ID: NCT02890836).

Determining Physical and Mental Health Conditions Present in Older Adult Refugees: A Mini-Review.

In 2017, there were over 65 million displaced persons at the global level, with approximately 23 million of these people living as refugees around the world. In this same year, the US resettled 53,716 refugees, with the State of Utah receiving 954 of those refugees. Refugees, in general, often face health-related challenges upon resettlement. Since the health of aging refugee men and women is of growing concern, host communities face significant challenges in accommodating the health needs of a diverse refugee population. This study, a review of physical and mental health data from the Utah Department of Health, was undertaken in an effort to ascertain the prevalence of health conditions among refugee men and women 60 years and older arriving in Utah. Findings include information on diseases correlated with increasing age, such as hypertension, decreases in vision, arthritis, and low back pain, which are common among this population of refugees aged 60 years and older. Overall, most of the health conditions assessed affect women and men with a similar prevalence. Some notable exceptions are a history of torture and violence, and a propensity for tobacco use. When dealing with refugee men older than 60 years, providers should consider the psychological ramifications of having endured such atrocities, as well as introduction to evidence-based tobacco cessation programs. When working with refugee women of the same age, an increase in the prevalence of musculoskeletal pain and urinary tract infections should be considered.

How Would Americans' Out-of-Pocket Costs Change If Insurance Plans Were Allowed to Exclude Coverage for Preexisting Conditions?

Issue: A current Republican legislative proposal would permit insurers to offer plans that exclude coverage of treatment for preexisting health conditions, even while the bill would maintain the Affordable Care Act's rule prohibiting denial of coverage to people with a preexisting condition. Goal: Estimate patients' out-of-pocket costs for five common preexisting conditions if the bill were to become law and assess any additional impact on out-of-pocket expenditures if spending on care for preexisting conditions no longer counted against plan deductibles. Methods: Analysis of 2014­2016 Medical Expenditure Panel Survey data for the privately insured adult population under age 65; and the proposed Ensuring Coverage for Patients with Pre-Existing Conditions Act (S. 3388). Findings and Conclusion: If preexisting conditions were excluded from coverage, nearly all people with these conditions would see increased out-of-pocket costs. Average out-of-pocket costs for those with cancer or diabetes would triple, while costs for arthritis, asthma, and hypertension care would rise by 27 percent to 39 percent. Some individuals would see much larger increases: for example, 10 percent of diabetes patients could expect to incur over $9,200 annually in out-of-pocket costs. Many with preexisting conditions also would spend more on conditions that are not excluded, since out-of-pocket spending on their preexisting conditions would no longer count toward the deductible and out-of-pocket maximum.

Preexisting psychiatric illness worsens acute care outcomes after orthopaedic trauma in obese patients.

PURPOSE: Pre-existing psychiatric illness, illicit drug use, and alcohol abuse adversely impact patients with orthopaedic trauma injuries. Obesity is an independent factor associated with poorer clinical outcomes and discharge disposition, and higher hospital resource use. It is not known whether interactions exist between pre-existing illness, illicit drug use and obesity on acute trauma care outcomes. PATIENTS AND METHODS: This cohort study is from orthopaedic trauma patients prospectively measured over 10 years (N = 6353). Psychiatric illness, illicit drug use and alcohol were classified by presence or absence. Body mass index (BMI) was analyzed as both a continuous and categorical measure (<30 kg/m2 [non-obese], 30-39.9 kg/m2 [obese] and ≥40 kg/m2 [morbidly obese]). Main outcomes were the number of acute care services provided, length of stay (LOS), discharge home, hospital readmissions, and mortality in the hospital. RESULTS: Statistically significant BMI by pre-existing condition (psychiatric illness, illicit drug use) interactions existed for LOS and number of acute care services provided (ß values 0.012-0.098; all p < 0.05). The interaction between BMI and psychiatric illness was statistically significant for discharge to locations other than home (ß = 0.023; p = 0.001). DISCUSSION: Obese patients with orthopaedic trauma, particularly with preexisting mental health conditions, will require more hospital resources and longer care than patients without psychiatric illness. Early identification of these patients through screening for psychiatric illness and history of illicit drug use at admission is imperative to mobilize the resources and provide psychosocial support to facilitate the recovery trajectory of affected obese patients.

Health status of homeless persons: a pilot study in the Padua municipal dorm.

OBJECTIVES: Homeless persons can be considered a vulnerable group and several studies showed in this group an higher prevalence of chronic and infectious diseases, a lower mental health status, and a higher abuse of alcohol. The aim of our study was to investigate the health status of homeless in Padua, Italy, administering a questionnaire composed by SF-36 and EQ-5D. DESIGN: We conducted a cross-sectional study from 15 December 2015 to 15 February 2016. SETTING AND PARTICIPANTS: We enrolled in our study 73 homeless persons welcomed in the municipal dorm of Padua. 5 persons refused to participate in the study; 9 had a mental status incompatible with the participation to the study. MAIN OUTCOME MEASURES: We administered to the participants a questionnaire composed by three parts: in the first part we asked sociodemographic information (gender, age, nationality, qualification, height and weight) to calculate BMI, time spent at the dorm, period of homelessness, alcohol intake, smoking habit, availability of a general practitioner, emergency room visits in the last year, admissions in the last year, pre-existing conditions and in act, participation in screening programs. The second part was represented by the Short Form 36 questionnaire. The third part by the EQ-5D questionnaire. RESULTS: Our sample was composed by 79% men and 21% women. 54.7% were Italian. The mean age was 48 years. 72.8% were smoker and 60,3% drunk alcohol. In this latter group 28.8% drunk more than 1 liter of wine per day. Non Italian homeless smoke less than the Italian: this difference is statistically significant (OR = 3.7 p = 0.032 ). Only 9 foreigners had a general practitioner compared to 30 Italian homeless: this difference is statistically significant (OR = 60 P < 0.01). 43 of the 59 respondents (72.8 % ) said to suffer from some disease. No one reported a history of tuberculosis. The most represented diseases were pneumonia (30%), myocardial infarction (17%), hepatitis C (13.5%). Participation in screening programs was very low. From the analysis of the SF-36 results, homeless persons obtained lower scores than Italian population. In our study, 40 persons reported a level 2 or 3 in the EQ-5D dimension called "anxiety/ depression". In the EQ visual-analogue scale, the homeless population showed a lower perception of its health status. CONCLUSION: Compared to the general population, the homeless reported a worse mental health, and this showed that they represent a particularly vulnerable group. Moreover they had a higher percentage of incorrect habits for their health (alcoholism and tobacco addiction), they suffered from chronic conditions, and tended to have a higher frequency of accesses to the emergency rooms. It would be better to improve the state of health of the homeless, through initiatives that could reduce the causes of homelessness, and that could prevent the onset of diseases in this group.

The demographics and diving behaviour of DAN Asia-Pacific members with and without pre-existing medical conditions.

INTRODUCTION: This report examines Diver Alert Network Asia-Pacific (DAN AP) members with and without cardiac or respiratory conditions, diabetes or hypertension and compares their demographics, health and diving activities. METHODOLOGY: Two online cross-sectional surveys of DAN AP members were conducted. The first sought information from 833 divers who applied for membership between July 2009 and August 2013 and who had declared the targeted medical conditions. The second, conducted between December 2014 and April 2015, was sent to 9,927 current members with known email addresses. The groups were compared for age, gender, body mass index, fitness, smoking and diving qualifications, history, currency and practices. RESULTS: Of 343 (41%) respondents to the first survey, 267 (32%) provided sufficient information for inclusion. Of 1,786 (18%) respondents to the second survey, 1,437 (15%) had no targeted medical condition and were included in the analysis. Those with medical conditions were on average 4.7 years older (P 〈 0.001); more overweight or obese (68% versus 57%, P = 0.001); took more medications (57% vs. 29%, P 〈 0.001), smoked less (4% vs. 7%, P = 0.02) and did less repetitive diving (median 75 vs 90, P 〈 0.001). Other diving demographics were similar. CONCLUSIONS: A substantial number of people are diving with medical conditions and there is a need to better understand the associated risks. Divers need to be well-educated about the potential impact such conditions may have on diving safety and should monitor their health status, especially as they age.

Is Dysphagia After Cardiac Operations a "Preexisting Condition"?

BACKGROUND: Controversy exists about the incidence of dysphagia after cardiac operations, and very little is known about the baseline risk in this patient population. This study evaluated the incidence of dysphagia both preoperatively and postoperatively in patients undergoing cardiac operations. METHODS: Patients undergoing cardiac operations were screened for dysphagia preoperatively using a 90-mL water swallow challenge protocol, a mini cognitive/speech screen, and a modified oral mechanism screen. The tests were repeated after extubation once the patient was alert and oriented. Patient characteristics were analyzed in conjunction with the results of the swallow screens to identify risk factors for dysphagia. RESULTS: Of 176 patients tested, 15 (8.5%) failed the swallow screen preoperatively. Age, gender, and comorbidities were compared. Patients who failed the swallow study preoperatively were slightly older (76.1 vs 73.3 years, p = 0.047) and had a higher incidence of chronic renal failure (13.3% v. 0.6%, p = 0.017), but gender and other comorbidities were not significantly different. Postoperatively, 38 patients failed the swallow screen (21.6%). Those who failed the postoperative screen were also older (75.6 vs 72.9 years, p = 0.012), but other factors (including chronic renal failure) were not significantly different. All of the patients who failed the swallow screen preoperatively also failed postoperatively. CONCLUSIONS: Unrecognized dysphagia in patients who need cardiac operations is a common problem and accounts for a substantial portion of that seen postoperatively. Older patients are at increased risk of dysphagia, but gender and medical comorbidities are not useful predictors of this risk.