Myxoid Pseudotumor Changes Affecting the Distal Ureter Associated With Urothelial Carcinoma In Situ.

Myxoid pseudotumor is a pseudoneoplastic fibroblastic proliferation that has been described in the perinephric and renal sinus fat tissue. It is characterized by the presence of a myxoid matrix, intermingled with the adipocytes, and a hypocellular population of spindle-shaped and stellate cells. We report a myxoid pseudotumor involving the distal ureter, which broadens the spectrum of possible localizations of this lesion around the urinary tract. It occurred in an 80-year-old patient who underwent a nephroureterectomy indicated after an incidental radiological finding of a thickening of the distal left ureter wall which suggested a ureteral neoplasm. He had two voided urine and one ureteroscopic sample cytologies diagnosed as high-grade urothelial carcinoma, as well as a retrograde ureteroscopy ureteral biopsy which was diagnosed as urothelial carcinoma in situ. This emphasizes the problem of the possible misdiagnosis of myxoid pseudotumor as a ureteral infiltrative carcinoma due to the radiological findings being badly interpreted, compounded by the preoperative cytohistologic data on malignancy. A diffuse urothelial carcinoma in situ was seen in our specimen without infiltrative or papillary tumors. This would not support an obstructive pathogenetic mechanism as has been hypothesized for myxoid pseudotumor.

Olanzapine/Samidorphan: A New Option for the Treatment of Adults With Schizophrenia or Bipolar I Disorder.

Objective: To review the pharmacology, pharmacokinetics, and efficacy and safety data of a combination of olanzapine and samidorphan (OLZ/SAM) for the treatment of schizophrenia and bipolar I disorder, which mitigates the possible unwanted side effects of weight gain associated with olanzapine (OLZ). Data Sources: The review was done with a bibliographic survey of studies using MEDLINE/PubMed (January 1999-May 2021) database using the keywords olanzapine and samidorphan. Abstracts, scientific posters, and information from the manufacturer's product labeling were evaluated for inclusion. Inclusion criteria: phase 2, phase 3, and open-labeled studies that evaluated the use of OLZ/SAM for the treatment of schizophrenia and bipolar I disorder. Data Synthesis: We have included one phase 2 dose-ranging exploratory study, two phase 3 efficacy and safety studies, and several open-label extension studies without a comparator. For the treatment of schizophrenia, OLZ/SAM and OLZ alone were analyzed in 2 randomized, double-blind comparison studies of approximately 960 patients. Analysis indicated that OLZ (5-20 mg)/SAM (10 mg) significantly mitigated the side effect of weight gain compared with OLZ alone (control) while maintaining antipsychotic efficacy. For bipolar I disorder, OLZ/SAM was approved as an acute treatment for manic or mixed episodes, as well as an adjunct to valproate or lithium for manic/mixed episodes based on bridging strategy allowed by the Food and Drug Administration. Relevance to Patient Care and Clinical Practice: The combination of olanzapine and samidorphan demonstrated efficacy for the treatment of schizophrenia with a dosage range of 5 to 20 mg OLZ to a 10-mg fixed dose of samidorphan. Advantages of this drug combination include once-daily dosing, favorable tolerability, and most importantly, mitigation of weight gain, which may encourage adherence, when compared with OLZ alone. Conclusion: The new combination treatment of OLZ/SAM is a unique antipsychotic formulation to provide the recognized efficacious treatment of OLZ, while mitigating the weight gain and possibly the weight-related adverse effects secondary to OLZ monotherapy.

Lumateperone: A Novel Antipsychotic for Schizophrenia.

OBJECTIVE: To provide a concise review of the new Food and Drug Administration (FDA)-approved antipsychotic, lumateperone, for use in schizophrenia. DATA SOURCES: A literature search of PubMed was performed (January 2000 to May 2020) using the following key terms: lumateperone, Caplyta, and ITI-007. Abstracts from conferences, review articles, clinical trials, and drug monographs were reviewed. STUDY SELECTION AND DATA EXTRACTION: Relevant English-language monographs and studies conducted in humans were considered. DATA SYNTHESIS: Lumateperone was FDA approved for the treatment of schizophrenia in December 2019 based on 2 published randomized, double-blind, placebo-controlled trials. Lumateperone's pharmacology is consistent with that of other second-generation antipsychotics in that it has a higher affinity for the serotonin (5-HT2A) receptors compared with dopamine (D2) receptors but with lower affinities for α-1 and histaminergic receptors. In addition, it serves as a presynaptic dopamine partial agonist, serotonin reuptake inhibitor, and an indirect modulator of glutamatergic systems. Based on the 4-week clinical trials, lumateperone was well tolerated. Most common treatment-emergent adverse events were headache, somnolence, and dizziness. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: At this time, lumateperone had a statistically significant reduction in Positive and Negative Syndrome Scale when compared with placebo and was not significantly associated with the extrapyramidal symptoms (EPS) and metabolic adverse effects commonly seen with other antipsychotics. CONCLUSIONS: Lumateperone has the potential to benefit individuals with schizophrenia who are intolerant to the EPSs or metabolic adverse effects of other antipsychotics. However, further head-to-head trials with commercially available antipsychotics are still required to assist in establishing its role in treatment.

PerserisTM: A New and Long-Acting, Atypical Antipsychotic Drug-Delivery System.

Perseris: A new, long-acting, atypical antipsychotic drug-delivery system.

Intranasal Esketamine (SpravatoTM) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant.

Intranasal esketamine for treatment-resistant depression.

Valbenazine (Ingrezza): The First FDA-Approved Treatment for Tardive Dyskinesia.

Valbenazine (Ingrezza): the first FDA-approved treatment for tardive dyskinesia.

Carcinoma sarcomatoide de laringe. ¿Un reto histológico? / Sarcomatoid carcinoma of larynx. A histological challenge?

Introducción. El carcinoma sarcomatoide puede aparecer en cualquier parte del cuerpo, siendo las glándulas salivales mayores su principal localización en cabeza y cuello, pero en la laringe representa aproximadamente un 1%. Cuenta con componentes epiteliales y mesenquimales, lo que ha llevado a plantear múltiples teorías acerca de su origen. Por esto su diagnóstico anatomopatológico puede ser un reto. Caso clínico. Presentamos un caso clínico de un varón de 76años fumador que consulta por disfonía. Se observa una lesión en cuerdas vocales sin adenopatías ni metástasis. Se le realiza microcirugía laríngea con escisión completa de la lesión, y el diagnóstico anatomopatológico es de carcinosarcoma, mostrando positividad intensa y difusa para vimentina y focal para AE1-AE3, CK5 y p63. El paciente recibe tratamiento complementario con radioterapia. Discusión. El carcinoma sarcomatoide tiende a manifestarse con síntomas obstructivos como la disfonía. Su pronóstico depende del estadio y de si hay o no metástasis. Suelen ser positivos los marcadores epiteliales citoqueratina (AE1-AE3), antígenos de membrana epitelial (EMA), Ki 67 y marcadores mesenquimales como vimentina, desmina y S-100. En cuanto al tratamiento, se recomienda de entrada una biopsia por escisión seguida o no de radioterapia complementaria, aunque la radioterapia sola también ha tenido éxito (T2-T1). En estadios T3-T4 pueden ser tratados con resección local, laringectomía parcial, total con o sin vaciamiento, seguida de radioquimioterapia concomitante (AU)

Introduction. Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. Case report. A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. Discussion. Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy (AU)

[Sarcomatoid carcinoma of larynx. A histological challenge?] / Carcinoma sarcomatoide de laringe. ¿Un reto histológico?

INTRODUCTION: Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. CASE REPORT: A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. DISCUSSION: Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy.

Flibanserin (Addyi): The First FDA-Approved Treatment for Female Sexual Interest/Arousal Disorder in Premenopausal Women.

Flibanserin (Addyi) for female sexual interest/arousal disorder in premenopausal women.

Brexpiprazole (Rexulti): A New Monotherapy for Schizophrenia and Adjunctive Therapy for Major Depressive Disorder.

Brexpiprazole (Rexulti): a new monotherapy for schizophrenia and adjunctive therapy for major depressive disorder.

Invega Trinza: The First Four-Times-a-Year, Long-Acting Injectable Antipsychotic Agent.

Paliperidone palmitate three-month injection (Invega Trinza): the first four-times-a-year, long-acting injectable antipsychotic agent for schizophrenia.

Naltrexone/Bupropion ER (Contrave): Newly Approved Treatment Option for Chronic Weight Management in Obese Adults.

Naltrexone/bupropion ER (Contrave): newly approved treatment option for chronic weight management in obese adults.

Cognitive and Performance Enhancing Medication Use to Improve Performance in Poker.

Use of neuroenhancers has been studied in groups ranging from students to surgeons; however, use of cognitive and performance enhancing medications (CPEMs) to improve performance in poker has remained largely overlooked. To assess the use of CPEMs to improve poker performance, a survey of poker players was conducted. Participants were recruited via Internet poker forums; 198 completed the online survey. Approximately 28 % of respondents used prescription CPEMs, with the most commonly used including: amphetamine/dextroamphetamine (62 %), benzodiazepines (20 %), and methylphenidate (20 %). CPEMs were used in poker to focus (73 %), calm nerves (11 %), and stay awake (11 %). Caffeine (71 %), as well as conventionally counter-intuitive substances like marijuana (35 %) and alcohol (30 %) were also reported to enhance poker performance. Non-users of CPEMs were dissuaded from use due to not knowing where to get them (29 %), apprehension about trying them (26 %), and legal or ethical concerns (16 %). Respondents most frequently acquired CPEMs via friends/fellow poker players (52 %), or prescription from physician (38 %). Additionally, greater use of CPEMs was associated with living outside the United States (p = 0.042), prior use of prescription medications for improving non-poker related performance (p < 0.001), and amateur and semi-professional player status (p = 0.035). Unmonitored use of pharmacologically active agents and their methods of acquisition highlight safety concerns in this cohort of poker players, especially among non-professional players. The current state of guidance from national organizations on CPEM use in healthy individuals could impact prescribing patterns.

Vortioxetine (brintellix): a new serotonergic antidepressant.

Vortioxetine (Brintellix): a new serotonergic antidepressant.

Loxapine inhalation powder (adasuve): a new and innovative formulation of an antipsychotic treatment for agitation.

Loxapine inhalation powder (Adasuve): an innovative formulation of an antipsychotic treatment for agitation.

Phentermine/Topiramate extended-release capsules (qsymia) for weight loss.

Phentermine/topiramate extended-release capsules (Qsymia) for weight loss.

Prevalence of hazardous alcohol use among pharmacy students at nine U.S. schools of pharmacy / Prevalencia del uso peligroso de alcohol entre estudiantes de farmacia en nueve facultades de farmacia en los Estados Unidos

Hazardous use of alcohol continues to be recognized as a problem at the university level. Knowledge regarding alcohol consumption in healthcare professional students is limited, especially in regards to pharmacy students. Much of the information available focuses on pharmacy student drinking patterns in specific geographic regions or is simply outdated. Objectives: This study was designed to assess levels of alcohol consumption and estimate the level of hazardous drinking among pharmacy students in a larger sample size that is representative of US pharmacy schools. Methods: An anonymous survey regarding alcohol usage was offered to students at nine schools of pharmacy across the United States. The survey consisted of demographic questions, the World Health Organization Alcohol Use Disorders Identification Test (AUDIT), and questions that assess particular alcohol-induced behaviors. Results: More than 25% of 1161 respondents had a total AUDIT score > 8, which indicates a risk of alcohol-related problems. Students that were male, in their first or second professional year of school, not married, and without children were statistically more likely to have AUDIT scores in the hazardous drinking range. Grade point average and student housing did not statistically affect student´s AUDIT scores. Conclusion: These results indicate that over one-fourth of pharmacy students surveyed have indicators of harmful alcohol use. Pharmacy schools should continue to address and confront hazardous alcohol use on campuses in order to curtail heavy alcohol consumption and reduce the risk of alcohol-related problems in pharmacy students (AU)

El uso peligroso de alcohol continua siendo reconocido como un problema de salud pública en las Universidades. El conocimiento sobre el uso de alcohol entre los profesionales de la salud es limitado, especialmente en relación a los estudiantes de farmacia. Mucha de la información disponible se centra en los patrones de consumo en estudiantes de farmacia en determinadas regiones geográficas o simplemente esté obsoleta. Objetivos: Este estudio fue diseñado para evaluar los niveles de consume de alcohol y estimar el nivel de consume peligroso entre estudiantes de farmacia en una gran tamaño de muestra que es representativo de las facultades de farmacia de los Estados Unidos. Métodos: Se ofreció un cuestionario anónimo sore el consumo de alcohol a estudiantes de nueve facultades de farmacia de los Estados Unidos. El estudio consistió en preguntas demográficas, el World Health Organization Alcohol Use Disorders Identification Test (AUDIT), y preguntas que evaluaban comportamientos particulares sobre el alcohol. Resultados: Más del 25% de los 1161 respondentes tenían una puntuación en el AUDIT de 8 o más, lo que indica un riesgo de problemas relacionados con el alcohol. Los estudiantes hombres, en su tercer o cuarto año de facultad, no casados, y sin hijos tenían más probabilidad de puntuaciones AUDIT en la zona de consumo peligroso. Las calificaciones y el alojamiento no afectaron estadísticamente a las puntuaciones AUDIT. Conclusión: Estos resultados indican que más de uno de cada cuatro estudiantes de farmacia encuestados tienen indicadores de uso peligroso de alcohol. Las Facultades de Farmacia deberían seguir afrontando el uso peligroso de alcohol en sus campus para restringir el consumo intenso de alcohol y reducir el riesgo de problemas relacionados con el alcohol en los estudiantes de farmacia (AU)

A comparison of the NCT Reichert R7 with Goldmann applanation tonometry and the Reichert ocular response analyzer.

PURPOSE: The aim of this study was to evaluate the accuracy of intraocular pressure (IOP) values from the new non-contact tonometer (NCT) Reichert R7 by comparing results with those from Goldmann applanation tonometry (GAT) and the Reichert Ocular Response Analyzer (ORA). Other ocular dimensions were assessed to evaluate their potential influence on the IOP values obtained. METHODS: Ninety two right eyes from 92 adults aged between 21 and 59 years (mean 34.9 ± 11.7 years) were enrolled in this study. IOP was measured with R7, ORA and GAT. All measurements were taken between 14:00 and 16:00 in the afternoon. Corneal resistance factor (CRF) and corneal hysteresis were measured with the Reichert ORA. The spherical equivalent refractive error was obtained using an open field auto-refractor (WAM5500; Grand Seiko) and corneal curvature, anterior chamber depth, corneal diameter and axial length were assessed with an optical coherence biometer (IOL Master; Zeiss Meditec, CA, USA). RESULTS: The mean values for IOP measurements were 15.20 ± 3.37 mmHg (R7), 13.49 ± 3.55 mmHg (GAT), 15.01 ± 3.38 mmHg (ORA IOPcc) and 14.44 ± 3.47 mmHg (ORA IOPg). With the exception of the CRF (ρ = 0.72 p < 0.001) the correlations between ocular parameters and IOP obtained with the R7 were neither statistically nor clinically significant. CONCLUSIONS: The new NCT, R7 overestimated the IOP compared with GAT in normal, healthy eyes by about 1.7 mmHg on average (95% confidence range of approximately -2 to +6 mmHg). The measures provided by the R7 were significantly influenced by the stiffness of the corneal tissue as measured by the ORA CRF value but not by other dimensional parameters of the eye.