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A Rare Incidence of Pseudoangiomatous Stromal Hyperplasia (PASH) in a Senior Adult Male: A Case Report Highlighting a Novel Presentation
No full textBackground: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign mesenchymal lesion of the breast that is most commonly seen in young premenopausal and perimenopausal females and found in approximately 23% of breast specimens. In rare cases, PASH has been reported exclusively in young adult males and is associated with gynecomastia. The prevalence of benign breast masses in men with gynecomastia ranges from approximately 23.8-47.4% and peaks between the ages of 50 and 80. PASH frequently presents as a palpable mass or is incidentally identified through imaging and microscopy. Due to its varied and infrequent presentations, PASH is often mistaken for malignancy or other breast lesions, particularly in senior adult males (over 65 years old), an age group commonly affected by benign breast masses and male breast cancer. Given its rare and diverse presentation, it is crucial to consider PASH in the differential diagnosis of a male patient with a benign breast tumor to guide appropriate management, avoid overtreatment, and ensure prompt evaluation for any underlying abnormalities.
Case presentation: This report presents a unique case of PASH in a senior adult male, aged over 65 years, who presented with an enlarging palpable areolar mass. Notably, the patient had no family history or past medical history of breast cancer. Imaging studies, including mammography and ultrasound, revealed mild gynecomastia and BIRADS-4 classification, prompting further investigation. A core needle biopsy confirmed the diagnosis of PASH, showing no evidence of carcinoma or malignancy. Given the mass\u27s progressive enlargement, surgical excision was recommended and successfully performed.
Conclusions: This report outlines the patient\u27s clinical presentation, diagnostic evaluation, and management while also providing a brief review of the limited literature. It is the first report to describe the presentation and management of PASH in a male over 65 years old with no history of abnormal breast pathology. Understanding atypical cases of PASH is essential for accurate diagnosis and appropriate management in this patient demographic
The Role of Juror Mental Health Experience in Not Guilty by Reason of Insanity Verdicts
No full textA not guilty by reason of insanity (NGRI) plea is a legal defense in which the defendant admits to the allegations against them, while asserting they should not be held criminally liable due to the role of a mental illness at the time of the offense. Ultimately, either a judge or a panel of jury members determine whether that plea is substantiated by a preponderance of the evidence. Although jurors are instructed to consider only the evidence presented during a trial, much of the literature on the subject demonstrates an abundance of extraneous variables that can influence individual juror decision-making. Albracht & Behnken (2019) established a significant relationship between mock juror experience with mental illness and perception of defendant culpability. That is, participants serving as simulated jury members in a research study who have a mental disorder are more inclined toward a particular verdict. To build upon these findings, the current study aimed to identify whether the diagnostic category of a mock juror\u27s psychiatric diagnosis is predictive of returning a particular verdict (i.e., NGRI, guilty). Researchers hypothesized that mock jurors diagnosed with a trauma and stressor-related, schizophrenia-spectrum, and neurodevelopmental disorders would find the defendant NGRI at a higher rate than individuals with no psychiatric diagnosis. Ultimately, a lack of participants endorsing schizophrenia-spectrum disorders resulted in their removal from analysis. Utilizing a logistic regression, statistical analysis led to the rejection of the hypothesis; however, exploratory analysis revealed statistically significant results between the endorsement of anxiety and depressive disorders and NGRI verdicts
Measuring Psychologists’ Bias Toward the Forensic Population
No full textBias is an important area of research in reference to the justice system. To date, a significant amount of research has been done on the bias and stigma the general population has toward the forensic population, but research is still lacking in measuring that bias among psychologists. Previous research has indicated that bias can be higher among those with higher levels of expertise within a field, which implies that those who are regarded as experts in mental illness may still be vulnerable to the influence of bias. The perceived presence of evaluator bias by those within the forensic population has been shown to create a negative and often adversarial relationship between the evaluator and the patient, which can complicate the evaluation and treatment process. An assessment of forensic inpatient facilities found that a positive therapeutic relationship reduces symptomatology and increases engagement with services and medication adherence. The current study examined the presence of psychologist bias toward the forensic population by using a 2x2 factorial design. Psychologists and psychology graduate students with experience in the forensic evaluation process were recruited through convenience sampling and separated into two groups (high expertise and low expertise) via education level. The participants were presented with a vignette of either a forensic inpatient or a non-forensic inpatient. Then they were given three self-report scales measuring negative attitudes, and their scores were summed and used to quantify the level of bias toward the patient. The participants were then asked to provide discharge recommendations. These scores were then analyzed via a two-way ANOVA. It was hypothesized that those with the forensic vignette will exhibit higher levels of bias and those with higher levels of expertise will also exhibit higher levels of bias
The Emerging Role of Osteopathic Manipulative Medicine in Enhancing Quality of Life for Palliative and End-of-Life Patients: A Narrative Review
No full textPalliative and end-of-life care aim to minimize suffering and optimize the quality of life for individuals nearing the end of their lives. Osteopathic manipulative medicine (OMM) represents a potentially valuable nonpharmacological approach within this integrative care framework. Emerging evidence from clinical observations, small-scale studies, and foundational osteopathic principles suggests that OMM may help support patient comfort, alleviate certain symptoms, and contribute to dignity in care. Techniques such as myofascial release, cranial manipulation, and lymphatic drainage have been reported to improve comfort and emotional well-being; however, these findings are based primarily on limited and heterogeneous studies. This narrative review synthesizes current clinical evidence on the application of OMM in palliative and end-of-life care, focusing on its potential to manage multiple distressing symptoms, including pain, respiratory distress, fatigue, gastrointestinal issues, edema, and psychological stress. The review aims to provide an integrative understanding of OMM’s role in symptom management, identify evidence gaps, and propose directions for future research
Adolescent Athletic Coaches\u27 Perception of Player Mental Health and Mental Health Training
No full textThe present study investigated adolescent athletic coaches’ perceptions of their ability to handle player mental health. The current study explored mental health training for coaches and their beliefs surrounding it, including potential deficits in contemporary mental health training opportunities. Seventy-seven individuals who identified as coaches working with individuals between 7th grade and 12th grade were recruited as participants. The 77 Participants were asked to answer up to 10 open-ended questions about mental health training, their experiences with mental health issues, and areas where they would like to receive more or less training. The survey was conducted online and sent to them via Facebook groups and message boards that contained adolescent athletic coaches, as this provides access to coaches on a national level. It was expected that coaches would describe their mental health training as being inadequate, having not worked with mental health enough to be confident in handling crises, and this hypothesis was only partially supported, where coaches did not have a standardized view on supporting player mental health. The hypotheses that many coaches would have ideas on how they would like to see mental health training expanded, and that coaches would recognize a range of possible roles in supporting player mental health, were both supported. Coaches had a range of desired mental health topics to address, including resilience, distress tolerance, and motivational interviewing. Coaches also described a range of perceived roles between active or passive descriptions
Opioid-free Anesthesia: a Scoping Review of Efficacy, Safety, and Implementation Challenges
No full textBackground: Opioid-free anesthesia (OFA) is a multimodal strategy to avoid intraoperative opioids and minimize associated complications, though evidence remains variable.
Methods: A systematic search of PubMed and Google Scholar (2010–2025), supplemented by AI tools (Google Gemini) for earlier publications, summarized eligible studies (RCTs, cohorts, systematic reviews, and meta-analyses) comparing OFA to opioid-based anesthesia (OBA). Data were summarized following PRISMA-ScR guidelines.
Results: Across 23 randomized controlled trials and one cohort study, OFA consistently reduced PONV, while demonstrating analgesia and recovery outcomes comparable to OBA. Hemodynamic stability was variable, with dexmedetomidine-based OFA regimens sometimes associated with increased bradycardia and hypotension. PACU stay varied, ranging from 9 min shorter to 15–35 min longer with OFA. Long-term outcome data are limited.
Conclusion: OFA is a feasible approach that significantly reduces PONV while maintaining comparable analgesia and recovery. However, heterogeneous protocols, small sample sizes, and scarce long-term data limit external validity. Large, multicenter trials are needed to standardize OFA protocols and clarify long-term outcomes
The Epidemiology of US Upper Extremity Amputations: An Analysis of the Global Burden of Disease Database (1990-2019)
No full textBackground
Upper extremity amputations (UEAs) are medically, psychologically, and functionally devastating. This study aimed to evaluate region- and sex-specific differences in unilateral and bilateral upper extremity amputations in the United States (US) from 1990 to 2019.
Methods
The Global Burden of Disease (GBD) database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for upper extremity amputations in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p\u3c0.05.
Results
Between 1990 and 2019, unilateral upper extremity amputations in the US showed a 34.51% decrease in YLDs, 34.34% in prevalence, and 37.38% in incidence. Bilateral amputations decreased by 51.32%, 48.94%, and 56.80%, respectively. Men consistently had higher YLDs, prevalence, and incidence rates for unilateral amputations (p\u3c0.001). Regionally, the Northeast had the highest mean YLDs, prevalence, and incidence, while the South had the lowest. Men also experienced significantly higher rates of both unilateral and bilateral amputations across all regions compared to women (p\u3c0.05).
Conclusions
From 1990 to 2019, the US experienced declines in YLDs, prevalence, and incidence of upper extremity amputations. Men had higher rates than women across all regions. The Northeast exhibited the highest rates, while the South had the lowest. These findings underscore notable gender and regional disparities in upper extremity amputation trends
Isolated Ipsilateral Hemiparesis From a Pyramidal Decussation Infarct: A Rare Case Confirmed by Magnetic Resonance Imaging
No full textA 38-year-old male smoker with chronic hypertension, anxiety secondary to alcohol withdrawal, chronic alcohol use, and a history of noncompliance with prescribed medications presented with 2 weeks of progressive left-sided weakness, numbness, dizziness, and gait instability. He also reported a month-long history of facial drooping that had not been formally evaluated. Brain magnetic resonance imaging revealed a small acute/subacute infarct in the left posterolateral cervicomedullary junction, at the level of the pyramidal decussation, which produced ipsilateral motor and sensory symptoms. This is a rare presentation of a stroke causing purely ipsilateral neurologic deficits and served as an important reminder of neurologic anatomy caudal to the pyramidal decussation
G0/G1 Switch 2 Regulates Radiation Sensitivity of Human Head and Neck Cancer through a G1-lipid Checkpoint
No full textHead and neck squamous cell carcinoma (HNSCC) resistance to radiotherapy has prompted a need to develop adaptive radiation therapy protocols to improve patient outcomes. This study investigates the hypothesis that lipid metabolism regulates cell cycle phase-specific radiation sensitivity of HNSCC cells. Previous studies have shown that HNSCC tumors with a higher proportion of G0/G1 phase cells (low proliferative index, LPI) are more resistant to radiation compared to HNSCC tumors with a higher proportion of S/G2 phase cells (high proliferative index, HPI). RNA-seq and bioinformatics identified lipid metabolism as the major intrinsic pathway that differs between HPI and LPI HNSCC cultures. mRNA and protein levels of G0/G1 Switch 2 gene (G0S2), regulator of quiescence and lipid metabolism, were upregulated in LPI compared to HPI HNSCC cultures. G0S2 negatively regulates adipose triglyceride lipase (ATGL), resulting in less lipolytic activity. siG0S2 treatment of LPI cultures recruited cells into the proliferative cycle and exacerbated radiation sensitivity. To override G0S2 action, we incubated LPI cultures with the fatty acid palmitate and examined cellular metabolic stress markers. Compared to controls, LPI cultures treated with palmitate showed increased reactive oxygen species levels, lipid peroxidation and oxygen consumption rate coupled with increased mitochondrial fission. Furthermore, using the fluorescent based cell cycle real-time imaging system, we showed that palmitate treatment sustained cell proliferation (higher S/G2) compared to controls (higher G1). Palmitate treatment resulted in significant sensitization to radiation treatment and enhanced the efficacy of poly (ADP-ribose) polymerase (PARP) inhibitors. In summary, we demonstrate that G0S2-dependent lipid metabolism regulates cell cycle phase-specific radiation sensitivity of HNSCC cells and identify G0S2 and free fatty acids as novel targets for radiation therapy
Cefadroxil-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome After Double Mastectomy for Ductal Carcinoma In Situ: A Case Report
No full textDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a delayed hypersensitivity reaction to medications, characterized by a prodrome of malaise and fever, followed by skin and hematologic manifestations and end-organ damage. Typical causal agents of DRESS syndrome include allopurinol, aromatic anticonvulsants, and antibiotics. However, fewer than 3% of cases suggest cephalosporin-induced DRESS syndrome.
A 43-year-old female developed a diffuse, erythematous, pruritic rash encompassing her whole body after starting prophylactic cefadroxil therapy before a double mastectomy for ductal carcinoma in situ. Her rash continued to worsen despite discontinuation of cefadroxil and developed a fever, myalgias, and generalized weakness. In the emergency department, she was noted to be febrile (103.5 °F) with elevated liver enzymes and eosinophilia, consistent with DRESS syndrome. She was admitted to medicine for further management with systemic steroids, intravenous fluids, and close observation.
DRESS syndrome is a rare manifestation occurring after taking selected drugs. The signs and symptoms of DRESS syndrome may be indolent and persistent even after stopping the offending agent, as seen in this patient. Therefore, prompt treatment is necessary to prevent detrimental complications of the disease