Background Squamous cell carcinoma of the nasopharynx, oropharynx and hypopharynx constitutes a majority of head neck malignancies. The incidence-based mortality across different races has been noted to be divergent. This study analyzes the trend in incidence-based mortality from the years 2000 to 2017 amongst both the genders in Caucasian/White and African American/Black patients. Methods The Surveillance, Epidemiology, and End Results (SEER) Database was queried to conduct a nation-wide analysis for the years 2000 to 2017. Incidence-based mortality for all stages of nasopharyngeal, oropharyngeal and hypopharyngeal cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. t -test was used to determine statistically significant differences between various subgroups. Linearized trend lines were used to visualize the mortality trends of all sub groups. Results Across all races, the male to female gender disparity in mortality was ~1:3 in patients with nasopharynx and became worse to ~1:4 and ~1:5 for patients with oropharyngeal and hypopharyngeal cancers, respectively. Notably, the highest incidence-based mortality for nasopharyngeal cancers is seen in Asian/pacific Islander males and a similar peak is noted for hypopharyngeal cancers in African American/Black males. Incidence-based mortality rates (per 1000) for nasopharyngeal, oropharyngeal and hypopharyngeal cancer of all races and both the genders was noted to be divergent. Conclusion A significant gender disparity exists in all three pharyngeal cancers across all races. It is unclear if female gender is protective but further study is warranted in a stage-specific and age-specific manner to better understand this disparity.
Congenital sucrase isomaltase deficiency (CSID) is an autosomal recessive disorder which leads to chronic intestinal malabsorption of nutrients from ingested starch and sucrose. Symptoms usually present after consumption of fruits, juices, grains, and starches, leading to failure to thrive and malnutrition. Diagnosis is suspected on detailed patient history and confirmed by a disaccharidase assay using small intestinal biopsies or sucrose hydrogen breath test. Treatment of CSID consists of limiting sucrose in diet and replacement therapy with sacrosidase. Due to its nonspecific symptoms, CSID may be undiagnosed in many patients for several years. We present a case of a 50-year-old woman with persistent symptoms of bloating in spite of extensive evaluation and treatment.
Background The treatment of salivary gland tumors has not changed significantly in the past two decades. However, the increase in the geriatric population with these tumors poses a new challenge for their management. This study explores the incidence-based mortality trends in the geriatric and non-geriatric population for the time period of 2000 - 2014 and compares the trends between races. Methods Mortality data were extracted from the Surveillance, Epidemiology, and End Results (SEER) Database for the years 2000 - 2014. Incidence-based mortality for all stages of salivary gland tumors was queried and the results were grouped by age (geriatric vs. non-geriatric determined as 65 vs. below 65 years of age) and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T -test was used to determine statistically significant difference between various subgroups. Linearized trend lines were used to visualize the mortality trends between various subgroups (geriatric vs. non-geriatric and Caucasian vs. African American). Results Incidence-based mortality for salivary gland tumors has worsened since 2000 to 2014 for both geriatric and non-geriatric patients (P < 0.05). There was a statistically significant difference between these two groups in both Caucasian/White patients and African American/Black patients. Notably, the worst incidence-based mortality rates were noted in African American/Black non-geriatric patients followed by Caucasian/White non-geriatric patients. However, there was no statistical difference in incidence-based mortality between Caucasian/White patients and African American/Black geriatric patients. Conclusions The similarity in incidence-based mortality for geriatric patients with salivary gland tumors in both Caucasian/White patients and African American/Black groups suggests that the effects of race may not be pronounced in the elderly population. The high rate of incidence-based mortality in African American/Black non-geriatric patients may suggest environmental influence and warrants further study.
Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may cause symptoms of dyspnea, pleuritic chest pain, and syncope. In addition to the difficulty physicians face in the detection and diagnosis of malignant pericardial effusion, treatment may be challenging considering the cancer prognosis and cardiovascular stability of the patient. Despite the availability of several treatment modalities for malignant pericardial effusion, including chemotherapy and surgery, patients with lung cancer historically present with poor prognoses. In addition to lung adenocarcinoma with malignant pericardial effusion, this case was complicated by COVID-19 and malignancy-associated obstructive pneumonia. We present a case of a 64-year-old woman with advanced non-small cell lung carcinoma (NSCLC) with malignant pericardial effusion who, despite testing positive for COVID-19 and having obstructive pneumonia, had favorable outcomes following systemic therapy with combined chemo-immunotherapy.
Background Application of the fundamental principles of nutrition and exercise in clinical management can improve the outcomes of highly fatal diseases. The purpose of this study is to assess whether a knowledge gap in preventative measures of nutrition and exercise exists amongst medical students. We aim to see if current medical education provides students with the appropriate background for applying preventative medicine principles to clinical practice. Method Study participants were pooled from current 1st, 2nd, and 3rd year medical students. Of the total 614 students contacted, 42 1st year, 49 2nd year, and 45 3rd year students completed the survey. The survey consisted of 20 questions based on a 10-point Likert Scale that asked students to assess their own self-confidence on various aspects of nutrition and exercise education. Survey responses were aggregated and separated by year of medical training. Average response scores for each cohort were compared using a Mann-Whitney U test. Results Across the three classes, average self-confidence levels in baseline nutrition and exercise understanding were less than 6.6/10, and average confidence in their ability to educate patients on nutrition and exercise needs were less than 6.61/10. Yet, the average score for student perception of the importance of preventative medicine education was greater than 7.5/10. There were no statistical differences in scores amongst the three cohorts for 19 of 20 questions. Conclusion Finding no significant difference between self-confidence in an average 1st year and an average 3rd year medical student suggests an educational deficit in the current curriculum model. The self-confidence scores presented are concerning for poor understanding of exercise and nutritional science principles which could result in poor delegation of preventative advice in the clinical setting. As such, it appears that the current education model is not preparing students for counseling on patients regarding nutrition and exercise.
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