Relationship between Mindfulness-Based Stress Reduction and Immune Function in Cancer and HIV/AIDS

Objective: Chronic stress is widespread, and is detrimental to immune functioning and to overall physical and emotional health. These effects may be potentiated in patients with chronic illness, as high levels of chronic stress are common in this population. Numerous studies support the efficacy of mindfulness-based stress reduction (MBSR) in improving psychological functioning. If a strong relationship is found between MBSR and immune function, then MBSR may be implemented as a strategy to improve immune functioning and overall well-being. Methods: In the present review paper, the relationship between MBSR and immune function is evaluated. Empirical studies measuring immune markers as they relate to a standard MBSR intervention were reviewed. Relevant articles primarily involved patients with cancer or HIV. Therefore, the associations of immune measures with psychological distress are discussed, with an emphasis on patients with these conditions. A psychoneuroimmunological (PNI) framework was utilized to propose a mechanism for the relationship between MBSR and immune function. Results: Overall, the findings support a positive relationship between MBSR intervention and beneficial immunological outcomes. Variability in immune measures assessed across studies precludes pooling data to develop more conclusive results. Conclusions: MBSR has been shown to consistently improve emotional functioning and quality of life, and these effects appear to facilitate immune function

Typical Bronchial Carcinoid Metastasizing to the Brain: A Case Presentation

Introduction: Typicalbronchial carcinoid tumors are known for their relatively indolent behavior. There are only four reported cases in the medical literature describing typical bronchial carcinoids metastasizing to the brain. Little is known about the pathogenesis and presentation of this disease due to the very small patient population. CasePresentation: A 67-year-old Hispanic female presented to our hospital with a three-week history of right arm numbness and poor coordination. Computed tomography (CT) with intravenous contrast of the brain and subsequent magnetic resonance imaging demonstrated multiple enhancing nodular densities throughout the brain. CT with intravenous contrast of the chest, abdomen, and pelvis revealed a left hilar mass and a medial left upper lobe mass. Histopathological findings were consistent with a neuroendocrine neoplasm of bronchial origin. Conclusion: Although metastases to the central nervous system are very frequent with small cell carcinomas, their presence is very uncommon in well-differentiated neuroendocrine tumors such as the one we present here. This case raises questions about whether these tumors contain biomarkers that might predict a more aggressive behavior and if these patients might benefit from aggressive interventions similar to those taken in small cell carcinomas, such as prophylactic cranial radiation

A Review of Systemic Treatment in Metastatic Triple-Negative Breast Cancer

Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Although there have been many new treatment options approved by the Food and Drug Administration for ER/PR-positive and Her2/neu-amplified metastatic breast cancer, relatively few new agents have been approved for patients with mTNBC. There have been several head-to-head chemotherapy trials performed within the metastatic setting, and much of what is applied in clinical practice is extrapolated from chemotherapy trials in the adjuvant setting, with taxanes and anthracyclines incorporated early on in the patient's treatment course. Select synergistic combinations can produce faster and more significant response rates compared with monotherapy and are typically used in the setting of visceral threat or symptomatic disease. Preclinical studies have implicated other possible targets and mechanisms in mTNBC. Ongoing clinical trials are underway assessing new chemotherapeutic strategies and agents, including targeted therapy and immunotherapy. In this review, we evaluate the standard systemic and future treatment options in mTNBC

SUPPLEMENT USE AND GASTROINTESTINAL BLEEDING

The use of supplements, such as vitamins, over the counter (OTC) agents, and herbal remedies have become a popular complementary therapy for a variety of conditions. There have been case reports describing an increased risk of bleeding associated with these supplements. Our objective was to test the hypothesis that there is an increased incidence of gastrointestinal bleeds among patients who take supplements.Methods This was a prospective cohort, survey-based study of 100 patients seen at MSMC from February 2013 to August 2013. Data included patient age, sex, ethnicity, country of origin, alcohol use, medical comorbidities, information regarding previous gastrointestinal (GI) bleeds, laboratory values, as well as the use of supplements, multivitamins, and anticoagulants. Results Overall, 32% of patients who had gastrointestinal bleeding consumed supplements. More patients in the supplement group took NSAIDS 52.9% vs. 27.9%, p =0.07), whereas more patients in the no supplement group took the combination of ASA and clopidogrel (25.6% vs. 5.9%, p = 0.08). Patients in the supplement group were less likely to have an elevated international normalized ratio (INR between 1.3-2.0: 6.3% vs. 22.1%, p = 0.05). Patients not taking supplements were significantly more likely to have no intervention done (14.7%) vs. 0%, p = 0.02). Conclusion Supplement use within the community is very common. Although non-significant, patients taking supplements appeared to have more severe gastrointestinal bleeds that required more interventions. Larger studies are needed to better define the risks of GI bleeding with particular supplements. Keywords: alternative medicine; gastrointestinal bleeding; herbal supplement

Cognitive Behavioral Therapy for Insomnia, Mindfulness, and Yoga in Patients With Breast Cancer with Sleep Disturbance: A Literature Review

The number of patients with breast cancer diagnosed with sleep disturbance has grown substantially within the United States over the past 20 years. Meanwhile, there have been significant improvements in the psychological treatment of sleep disturbance in patients with breast cancer. More specifically, cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and yoga have shown to be 3 promising treatments with varying degrees of benefit, supporting data, and inherent limitations. In this article, we will outline the treatment approach for sleep disturbance in patients with breast cancer and conduct a comprehensive review of CBT-I, mindfulness, and yoga as they pertain to this patient population

Gastric Small-Cell Carcinoma Found on Esophagogastroduodenoscopy: A Case Report and Literature Review

Introduction. Characterized as an undifferentiated, neuroendocrine tumor arising from totipotent stem cells, small-cell carcinoma (SCC) most commonly arises from the lung. Extrapulmonary small-cell carcinomas (ESCC) are rare and account for only four percent of SCC. Gastric ESCC, more commonly seen in Japanese male patients in their seventh decade of life, accounts for approximately 0.1 percent of ESCC. Case Presentation. A 75-year-old Hispanic male presented with a several week history of worsening epigastric pain with nausea and vomiting. Computer tomography (CT) of the abdomen and pelvis showed a large heterogeneous mass involving the posterior gastric wall with diffuse extension into the gastric cardia. Esophagogastroduodenoscopy (EGD) revealed a large fungating mass in the lesser curvature of the stomach. Biopsy of the mass revealed small-cell carcinoma of the stomach. The patient was diagnosed with extensive/stage 4 disease and started on chemoradiation. Discussion. Our case, of a very rare condition highlights, the importance of recognizing atypical pathologic diagnoses. More research will need to be conducted with GSCC patients in order to better characterize disease pathogenesis, genetic mutations, and optimal disease management. The hope is to identify biomarkers that will identify patients earlier in their disease course when cure is possible

A De Novo Germline APC Mutation (3927del5) in a Patient with Familial Adenomatous Polyposis: Case Report and Literature Review

Introduction Characterized by the development of hundreds to thousands of colonic adenomas, classic familial adenomatous polyposis (FAP) is one of the most common hereditary syndromes associated with an increased risk of colorectal cancer. Several studies have attempted to correlate specific APC mutations with clinical phenotype. 6 However, there is considerable variability in the expression of specific phenotypes within families and among individuals with identical mutations. 7 Case Presentation A 30 year-old Hispanic female presented to the emergency department with a 2-week history of persistent, worsening, left lower quadrant abdominal pain. She had no family history of malignancy. Sigmoidoscopy revealed innumerable polyps in the rectum and sigmoid colon and a large mass in the sigmoid colon. Biopsy of the mass revealed a moderately differentiated adenocarcinoma invading the subserosa. Endoscopy revealed innumerable polyps. Genetic testing of the patient via southern blot revealed a germline APC mutation 3927del5, resulting in a premature truncation of the APC protein at amino acid position 1312. Conclusion Genetic information has only recently started being incorporated into clinical care. More research and randomized clinical trials need to be conducted to definitively characterize random mutations. Once these mutations are further understood, FAP patients may be able to be risk stratified and this may ultimately improve the screening, diagnosis, and treatment of this rare condition