Kaposiform hemangioendothelioma in tonsil of a child associated with cervical lymphangioma: a rare case report

Kaposiform hemangioendothelioma (KHE) is an uncommon vascular tumor of intermediate malignant potential, usually occurs in the extremities and retroperitoneum of infants and is characterized by its association with lymphangiomatosis and Kasabach-Merritt phenomenenon (KMP) in certain cases. It has rarely been observed in the head and neck region and at times, can present without KMP. Herein, we present an extremely uncommon case of KHE occurring in tonsil of a child, associated with a neck swelling, but unassociated with KMP. A 2-year-old male child referred to us with history of sore throat, dyspnoea and right-sided neck swelling off and on, since birth, was clinicoradiologically diagnosed with recurrent tonsillitis, including right sided peritonsillar abscess, for which he underwent right-sided tonsillectomy, elsewhere. Histopathological sections from the excised tonsillar mass were reviewed and showed a tumor composed of irregular, infiltrating lobules of spindle cells arranged in kaposiform architecture with slit-like, crescentic vessels. The cells displayed focal lumen formation containing red blood cells (RBCs), along with platelet thrombi and eosinophilic hyaline bodies. In addition, there were discrete foci of several dilated lymphatic vessels containing lymph and lymphocytes. On immunohistochemistry (IHC), spindle cells were diffusely positive for CD34, focally for CD31 and smooth muscle actin (SMA), the latter marker was mostly expressed around the blood vessels. Immunostaining for HHV8 was negative and Ki-67 (proliferation marker) displayed focal positivity. Diagnosis of KHE was made. Platelet count was towards lower side of range. Postoperative imaging showed discrete, multiple fluid containing lesions in the right neck that were high on T2-weighed sequences, on magnetic resonance imaging (MRI) and ipsilateral intraoral mucosal growth. Fine needle aspiration cytology (FNAC) smears from neck swelling showed blood, fluid and lymphocytes. Possibility of a coexisting lymphangioma was considered. The patient was offered sclerotherapy and is on follow-up. This case forms the second documented case of KHE at this site, along with its unique association with neck lymphangioma. KHE has distinct histopathological features and can be sorted out from its other differentials like juvenile hemangioma and Kaposi's sarcoma. IHC stains are useful in substantiating a definite diagnosis

Early-life predictors of resilience and related outcomes up to 66 years later in the 6-day sample of the 1947 Scottish mental survey.

PURPOSE: Psychological resilience, the ability to manage and quickly recover from stress and trauma, is associated with a range of health and wellbeing outcomes. Resilience is known to relate to personality, self-esteem and positive affect, and may also depend upon childhood experience and stress. In this study, we investigated the role of early-life contributors to resilience and related factors in later life. METHODS: We used data from the 6-day sample of the Scottish mental survey 1947, an initially representative sample of Scottish children born in 1936. They were assessed on a range of factors between the ages of 11 and 27 years, and resilience and other outcomes at 77 years. RESULTS: Higher adolescent dependability unexpectedly predicted lower resilience in older-age, as did childhood illnesses, while a count of specific stressors experienced throughout early life significantly predicted higher later-life resilience. We also observed significant cross-sectional correlations between resilience and measures of physical health, mental health, wellbeing and loneliness. Some of the associations between early-life predictors and later-life outcomes were significantly mediated by resilience. CONCLUSIONS: Our results support the hypothesis that stress throughout early life may help to build resilience in later-life, and demonstrate the importance of resilience as a mediator of other influences on health and wellbeing in older age. We suggest that the mechanisms determining how early-life stress leads to higher resilience are worthy of further investigation, and that psychological resilience should be a focus of research and a target for therapeutic interventions aiming to improve older-age health and wellbeing

data protection and ethical issues in european p5 ehealth

In spite of its promise to significantly ameliorate health and care practices, the momentous rise of eHealth technologies has been fraught with significant ethical and societal concerns. Focusing on the unfolding of eHealth within the European Union, this contribution will explore its underpinning regulatory landscape with regard to data protection, focusing on the impact of the recently enforced Regulation (EU) 2016/679, also known as the General Data Protection Regulation. In addition, this chapter will chart relevant ethical issues related to the emergence of novel eHealth technologies. Finally, the conclusion will briefly explore ethical issues and their solutions in the light of the P5 approach

Equivalence tests for one-way independent groups designs

Researchers in education are often interested in determining whether independent groups are equivalent on a specific outcome. Equivalence tests for 2 independent populations have been widely discussed, whereas testing for equivalence with more than 2 independent groups has received little attention. The authors discuss alternatives for testing the equivalence of more than 2 independent populations, and the use a Monte Carlo study to demonstrate and compare the performance of these alternatives under several conditions. The results indicate that a 1-way test (e.g., Wellek’s F test) is recommended for assessing the equivalence of more than 2 independent groups because approaches based on conducting pairwise tests of equivalence are overly conservative.Social Sciences and Humanities Research Council (SSHRC

Preferences for CPR among the elderly: the influence of attitudes and values.

OBJECTIVES: While many older individuals wish to forgo cardiopulmonary resuscitation regardless of potential positive outcomes, others desire this intervention despite low chances of survival. This study examines the extent to which health, function, attitudes, and values influence preferences for cardiopulmonary resuscitation. DESIGN: An in-person, physician-administered survey. SETTING: Three clinical sites affiliated with a university-based geriatrics program. PARTICIPANTS: One hundred three individuals age 65 or older with ability to speak, read, and write English. MEASUREMENTS: Demographic, health and functional status, social involvement, religiosity, attitudes, and values were assessed. A standard description of cardiopulmonary resuscitation was followed by open-ended questions regarding treatment preferences. RESULTS: Mean age was 81 (+/- 7), 66% were women and 78% had an advance directive. The majority (75%) declined cardiopulmonary resuscitation. Women were more likely to decline cardiopulmonary resuscitation. Attitudes toward life were the strongest predictors for the cardiopulmonary resuscitation decision. Family issues were important, especially the prospect of becoming a burden, as well as the outcome of cardiopulmonary resuscitation. CONCLUSION: Attitudes toward life, perceived outcome of cardiopulmonary resuscitation, and family issues play a significant role in end-of-life treatment decision-making

Preferences for CPR among the elderly: the influence of attitudes and values.

OBJECTIVES: While many older individuals wish to forgo cardiopulmonary resuscitation regardless of potential positive outcomes, others desire this intervention despite low chances of survival. This study examines the extent to which health, function, attitudes, and values influence preferences for cardiopulmonary resuscitation. DESIGN: An in-person, physician-administered survey. SETTING: Three clinical sites affiliated with a university-based geriatrics program. PARTICIPANTS: One hundred three individuals age 65 or older with ability to speak, read, and write English. MEASUREMENTS: Demographic, health and functional status, social involvement, religiosity, attitudes, and values were assessed. A standard description of cardiopulmonary resuscitation was followed by open-ended questions regarding treatment preferences. RESULTS: Mean age was 81 (+/- 7), 66% were women and 78% had an advance directive. The majority (75%) declined cardiopulmonary resuscitation. Women were more likely to decline cardiopulmonary resuscitation. Attitudes toward life were the strongest predictors for the cardiopulmonary resuscitation decision. Family issues were important, especially the prospect of becoming a burden, as well as the outcome of cardiopulmonary resuscitation. CONCLUSION: Attitudes toward life, perceived outcome of cardiopulmonary resuscitation, and family issues play a significant role in end-of-life treatment decision-making