An atypical presentation of Liposarcoma: Primary involvement of the liver with secondary metastatic seeding

A 61-year old male with PMH significant for gastric bypass, anxiety/depression, and previous alcohol abuse, presented to the ED with 10-day history of SOB and abdominal distention. He endorsed difficulty taking deep breaths, urinating, and bowel movements. He denied any unexplained weight loss, night sweats, or history of ascites. Physical exam revealed abdominal distension and tenderness. Hepatitis screen, AFP, CEA, and CA19-9 were negative. AST, ALT, total bilirubin, and alkaline phosphatase were all WNL. CT imaging demonstrated pleural effusion with atelectasis, large amounts of ascites with mesenteric stranding, and a 7cm mass of unknown etiology adjacent/medial to the liver. CT-guided biopsy of the perihepatic mass was consistent with well-differentiated liposarcoma. IR-guided biopsy of the omental mass demonstrated de-differentiated liposarcoma, FNCLCC grade 2. Colonoscopy to assess second primary tumor found three polyps demonstrating tubular adenoma. The patient was diagnosed metastatic primary liposarcoma of the liver. Soft tissue sarcomas comprise ~1% of all malignancies in adults. The majority of these arise from primary soft tissue, with bone as the next closest site of involvement. Liposarcomas are a subclass of soft-tissue sarcomas, arising from precursor adipocytes. Their primary focus is in the retroperitoneum and extremities. A liposarcoma with primary involvement of the liver is very rare. If the liver is involved it is usually from distant metastasis rather than a primary focus, though that is also rare. With only about a dozen cases of primary liver liposarcoma reported in the literature, the knowledge of the clinical course, management, and prognosis are limited.https://scholarlycommons.henryford.com/merf2020caserpt/1055/thumbnail.jp

Racial Disparities and Risk for COVID-19 Among Pregnant Patients: Results from the Michigan Statewide Collaborative

Objective: Previous studies have looked at COVID-19 outcomes in pregnancy and racial disparities among patients with COVID-19, but few have studied racial disparities among pregnant patients with COVID-19. Our goal in this study is to analyze the relationship between race and disparate COVID-19 risk in pregnancy. Study Design: A retrospective cohort analysis was performed on data collected as part of the COVID-19 in Pregnancy and The Newborn: State of Michigan Collaborative, a database of pregnant patients admitted to 14 institutions in Southern Michigan. Cases were defined as patients with a positive SARS-CoV-2 test result. Controls, those with suspicion of COVID-19 prior to universal screening or a negative PCR test, were matched to cases on the same unit within 30 days of each case. For this analysis, the two primary groups of interest were non-Hispanic Black (Black) vs. non-Hispanic White (White) patients. Potential covariates were age, body mass index (BMI), chronic hypertension, diabetes, asthma, substance use, and smoking; the dependent variable was COVID/non-COVID in a robust Poisson regression model. In addition, 18 symptoms and disease severity (mild/moderate/severe) were compared between the Black and White groups using the same statistical method. Results: Of 1,131 gravidas, 42.9%(n=485) were Black. These patients were at two-fold greater risk for COVID-19 compared with their White counterparts [35.9% vs. 18.3%, RR=1.96(1.6-2.4)]. After adjusting for obesity and diabetes, the risk of COVID-19 in Black patients remained higher compared to the risk among White patients (aRR=2.46 [1.87-3.24]). There were no differences in symptoms nor severity of disease presentation between the groups. Conclusion: In our population, Black patients are more likely to be diagnosed with COVID-19 infection during pregnancy. This finding is not explained by a range of covariates. Other factors, such as social determinants of health, may be important to understand this disparity and warrant further examination

Regarding the prospects for the introduction of the budgeting system of international financial organizations of the future

The purpose of the article is to analyze the prospects for the implementation of the budgeting system of international organizations in the future. Method. Methods of analysis, synthesis, induction and deduction, comparativistic and systematic method, forecasting were used to write the article. Content analysis of the literature was important: more than 20 theoretical articles out of more than 50, which were reflected in the search engines. The results considered the essence of the concept of budgeting. It is established that budgeting is a management technology, which, based on the specifics of the whole industry and established budgets ensure the work of both separate structural units and the organization as a whole through the use of planning tools, calculations, analysis, limitation, encouragement, control of income and expenditure, assets and liabilities. Also, the models of budgeting of financial institutions are analyzed, the basic forms of budgeting are defined, the connection between the latest technologies and the improvement of models of management of financial institutions is emphasized. The choice of the optimal model of budgeting is related to the availability of additional financial resources in the implementation of budgeting, the presence of appropriate specialists in the composition of the institution, the awareness of the importance of the process of optimization of non-productive costs. Conclusions. The conclusions conclude that an important role belongs to the decentralization of management - the transition from the simple division of managerial authority over functions to the assignment of the main tasks and indicators to the managers of the structural units

Racial Disparities in Risk for COVID-19 In Pregnancy: Results from the Michigan Statewide Collaborative

Objective: Though previous studies have looked at both COVID-19 outcomes in pregnancy and racial disparities among patients with COVID-19, few have specifically studied racial disparities among pregnant patients with COVID-19. Our goal in this study is to analyze the relationship, if any, between race and disparate COVID-19 risk in pregnancy. Study Design: A retrospective cohort analysis was performed on data collected as part of the COVID-19 in Pregnancy and The Newborn: State of Michigan Collaborative, an established database of pregnant patients admitted to 14 institutions in South Michigan. Cases were defined as patients with a positive SARS-CoV-2 test result. Controls, those who had no suspicion of COVID-19 prior to universal screening or a negative PCR test, were matched to cases on the same unit within 30 days of each case. For this analysis, the independent variable was race; potential covariates were age, body mass index (BMI), chronic hypertension, diabetes, asthma, substance use, and smoking; the dependent variable was COVID/non -COVID in a robust Poisson regression model. In addition, eighteen symptoms and disease severity (mild/moderate/severe) were compared between AA’s and Whites using the same statistical method. Results: Of 1,131 gravids, 42.9% (n=485) were AA. These patients were at two-fold greater risk for COVID-19 compared with their White counterparts [35.9% vs. 18.3%, RR=1.96(1.6-2.4)]. After adjusting for the risk factors mentioned, only obesity and diabetes independently contributed, in addition to race (aRR 2.46 [1.87-3.24]). There was no difference between AA and white with COVID-19 in either symptomatology and severity of disease presentation. Conclusions: There is disparity in risk for getting COVID-19 during pregnancy in AA patients. This is not explained by a range of covariate risk factors. Thus, other kinds of determinants such as SDoH, will need to be examined to understand this disparity. In addition to increased susceptibility to infection, further examination of disparities in treatment and outcome will be examined in our sample