Vitamin and Mineral Supplements Have a Nutritionally Significant Impact on Micronutrient Intakes of Older Adults Attending Senior Centers

Older adults frequently report use of vitamin and mineral (VM) supplements, although the impact of supplements on dietary adequacy remains largely unknown. The purpose of the current study was to evaluate micronutrient intakes of older adults with emphasis on identifying nutrients most improved by VM supplements, nutrients most likely to remain inadequate, and nutrients most likely consumed in excess. Community-based volunteers were recruited from senior centers and completed a questionnaire querying demographic data, current health status, and VM supplement use. Participants (n = 263) were then contacted by telephone to complete two 24-hour diet recalls and confirm VM supplement use. Dietary adequacy was determined by comparing the ratio of mean dietary intake to the Dietary Reference Intakes (DRI). Dietary consumption was lowest for vitamins D and E, calcium, and magnesium. VM supplementation most improved intakes of vitamins E, D, B₆, folic acid, and calcium. Participants were most likely to exceed the Tolerable Upper Limit with supplementation of niacin, folic acid, and vitamin A.     

DSM-V: modifying the postpartum-onset specifier to include hypomania

By failing to include it under the rubric of the postpartum-onset specifier, Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR has ignored the clinical reality that childbirth is a potent trigger of hypomania. Given the serious and occasionally tragic consequences of misdiagnosis of bipolar II depression as unipolar depression in the postpartum period, it is argued that DSM-V should consider modifying the postpartum-onset specifier to include episodes of hypomania.     

Pulmonary Blastoma Presenting as a Solitary Lip Metastasis: Case Report and Review of the Literature

Abstract

Pulmonary blastoma (PB) is an uncommon primary lung malignancy. This neoplasm was first described by Barrett and Barnard in 1945. The tumor is composed of immature epithelial and mesenchymal tissues which may recapitulate early embryological lung development. Under the microscope, the globular component resembles immature bronchus and connective tissue as seen in embryonic lung. More than one hundred cases have been reported in the literature. PB is more frequent in older people and in males and tends to affect blacks at younger ages. Symptomatology varies from asymptomatic to symptoms of a non-specific pulmonary disease. Cough, hemoptysis, dyspnea, chest pain, respiratory distress, fever, anorexia and weight loss are the most common presenting features. The most common roentgenologic pattern is a well-demarcated peripheral lesion, encapsulated by compression or atelectatic lung tissue, although in some cases there is a tendency to lobulation and cavitation. The size of the mass varies from a small peripheral nodule to a mass occupying the entire lobe or hemithorax. The treatment of choice has been surgical excision, radiation and, in selected cases, a combination of chemotherapy with radiation. The prognosis of this malignancy is poor; overall five-year survival is approximately 16 percent. No correlation has been established between histopathologic criteria and survival. The factors that indicate poor prognosis are tumor recurrence, metastasis at initial presentation, tumor size over 5 cm and lymph node metastasis. Liver, central nervous system and bones are the most frequent location of distant metastases. A rare case is presented of a pulmonary blastoma with an upper lip metastasis occurring in a paraplegic male. Diagnosis was confirmed by autopsy findings. To our knowledge, this is the first documented case of a pulmonary blastoma metastasis to the upper lip. (J Spinal Cord Med; 18:203–207)     

Do statins,ACE inhibitors or sartans improve outcome in primary glioblastoma?

The prognosis of the association between Breast Cancer (BC) and Meningioma (M) is unknown. To evaluate the survival impact of tumor exposure sequence in patients with both tumors. Patients were divided in groups according to the tumors sequence: BC before M (group 1), synchronous BC?+?M (group 2) and BC after M (group 3). The SEER database was used. Demographics, meningioma and breast cancer variables were analyzed. The primary outcome was oncological survival. A total of 1715 patients were included (median follow-up:84 months). Group 2 had the shortest survival (median:32 months) and group 1 the longest (median:110 months). On the unadjusted analysis, group 2 had the shortest survival (HR:3.13, 95% CI 1.62–6.04) and adjusted analysis confirmed this finding (HR 3.11, 95% CI 1.58–6.19), with no statistical difference between the metachronous tumors groups. Increasing age (HR:1.13, 95% CI 1.11–1.15, p?<?0.005) and grade III meningioma (HR:4.51, 95% CI 1.90–10.69, p?<?0.005) were related with lower survival. Meningioma treatment had no influence on the survival (p?>?0.05). The association between surgery and radiotherapy in BC treatment improved the outcome (HR 0.37, 95% CI 0.23–0.93, p?<?0.05). Grade III meningioma and receptor hormonal status influenced synchronous tumors (p?<?0.05) but had no influence on metachronous tumors survival (p?>?0.05) on stratified analysis. Synchronous tumors were associated with lower survival. Increasing age had a negative influence on patient survival. Although surgery and radiotherapy for breast cancer had a positive influence in the outcome, meningioma treatment was not related with survival. Grade III meningioma and hormonal receptor status only influenced synchronous tumors patient survival.