A patient with known prostatic cancer presented with left supraorbital swelling with proptosis and restricted eye movements on left eye. Contrast enhanced computed tomography scan revealed dural and bone metastases with soft tissue component extending to the left orbit. Serum prostate specific antigen was markedly elevated at >100 ng/ml. Incision biopsy of the orbital tumor revealed only lymphocytic inflammatory cells within the fibrous stroma attributed mainly to the deeper location of the tumor or shallow locus of the biopsy. Incisional biopsy of the frontal bone revealed atypical looking cells in sheet cluster with nuclear enlargement, hyperchromatic in irregularity confirming the diagnosis of orbital metastasis of prostate carcinoma.

Metastasis of prostate cancer to the orbit is rare. One should have a high index of suspicion of orbital metastasis when presented with an elderly patient with ocular symptoms and a history of prostate adenocarcinoma. A thorough clinical, radiological and histological evaluation is necessary to establish the diagnosis.

Human ; Male ; Aged ; Neoplasm Metastasis ; Adenocarcinoma ; Prostatic Neoplasms ; prostate-biopsy ; eye ; Tomography Scanners, X-Ray Computed

OBJECTIVES: To compare the effect of Tramadol, Tramadol/HNBB combination and Tramadol/Alfuzosine combination in the relief of renal colic.

MATERIALS AND METHODS: A total of 82 patients diagnosed with renal colic from May to October 2009 were included in the study. The patients were divided into three groups: Group I (n=27) was given Tramadol (50 mg/capsule orally) only, Group II (n=28) was given Tramadol and Hyoscine-N-Butylbromide (10 mg/tablet orally) and Group III was given Tramadol and Alfuzosine (10 mg/tablet orally). Pain was evaluated using the Visual Analog Scale pre-treatment and post-treatment.

RESULTS: The Visual Analog Scale scores for all groups showed improvement after treatment. The average difference in Visual Analog Scale for Group I was 3.148, Group II was 3.444, and Group III was 3.429. A significant difference was seen in all treatment groups. ANOVA was used to compare the differences between the three treatments. All treatments had comparable results, therefore, no significant difference was seen in the effect of the three treatments.

CONCLUSION: Relief of renal colic was achieved in all groups as seen in a decrease in the Visual Analog Scale Score after giving of treatment, however, the differences for each treatment group was not statistically significant.

Human ; Male ; Female ; Adolescent ; Child ; Renal Colic-Signs and Symptoms, treatment, management ; Visual Analog Scale-Diagnostic Techniques and Procedures ; Tramadol ; Butylscopolammonium Bromide

CLINICAL SCENARIO: A 46-year-old male consulted for refraction. Best-corrected visual acuity was 20/20 for both eyes (OU), Jaeger 1 for near. Slit-lamp examination was normal. Intraocular pressure (IOP) was 25 mm Hg OU. Gonioscopy revealed iridocorneal angles that were open up to the ciliary body band OU. Funduscopy revealed clear media with no exudates or hemorrhages in the retina. Cup-disc ratio was 0.7 vertically and 0.6 horizontally with notching of the inferotemporal neuroretinal rim OU. Automated visual-field examination showed superior arcuate scotomas OU with no threat to fixation. The working diagnosis upon consultation was primary open-angle glaucoma. After all treatment options had been explained to the patient, a trial of medical therapy was chosen. Given the severity of the glaucoma, a target IOP range was initially set at 15 to 17 mm Hg. Nonselective beta-adrenergic blockers and prostaglandin analogues are two classes of medications that will most probably lower the IOP to the desired levels CLINICAL QUESTION: Among patients undergoing initial medical therapy for primary open-angle glaucoma, would latanoprost be more effective in lowering the IOP compared with timolol? SEARCH METHOD: An electronic literature search was performed using Medline (PubMed). The key words used were "latanoprost" and "timolol." The search was further limited to randomized clinical trials or metaanalysis published in the English language. Table 1 shows the search process performed The search was narrowed down to 5 articles. Abstracts of the articles were reviewed. One article employed ocular hypertensive subjects while another compared brimonidine and timolol. These studies were, therefore, excluded. Among all the metaanalyses obtained from the search, Zhang et al.s had the most number of subjects and outcome measures. It was for this reason that the article was chosen for appraisal in resolving the clinical scenario. (Author)
TIMOLOL

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Although previous studies have demonstrated that exercise independently reduces hepatic steatosis measured by imaging modalities in NAFLD, the effect of exercise on histological endpoints remains unclear. We aimed to conduct a systematic review of the independent effect of exercise on hepatic steatosis, steatohepatitis, and liver fibrosis as measured by histological assessment or non-invasive tests (NITs) in biopsy-proven NAFLD. A systematic literature search of PubMed, Embase, and Web of Science databases was performed using keywords related to exercise, NAFLD, and biopsy. Articles were selected based on the following inclusion criteria: (1) involved human subjects with biopsy-proven NAFLD, (2) analyzed the independent effect of exercise, (3) assessed changes in hepatic steatosis, steatohepatitis, or liver fibrosis via either histological evaluation or NITs, and (4) were original research studies. We identified a total of six studies that analyzed the independent effect of exercise on histological endpoints in biopsy-proven NAFLD. Two randomized controlled trials (RCTs) did not detect significant histological improvement following exercise interventions, while other non-randomized interventional studies showed that exercise reduces hepatocyte ballooning and liver fibrosis. In addition, five studies assessed NIT outcomes, collectively demonstrating that exercise improves hepatic steatosis measured by magnetic resonance imaging-based techniques but not serum biomarkers for steatohepatitis and liver fibrosis. Additional large RCTs and meta-analyses are warranted to investigate the independent effect of exercise on histological and clinical outcome endpoints in NAFLD.

INTRODUCTIONWe appraised the roles and responsibilities assigned to community pharmacists internationally and in Singapore.

MATERIALS AND METHODSA systematic search of international peer-reviewed literature was undertaken using Medline. Grey literature was identified through generic search engines. The search period was from 1 January 1991 to 30 July 2009. The search criteria were English language manuscripts and search terms "community pharmacist", "community pharmacy", "disease management" and "roles" as a major heading. Boolean operators were used to combine the search terms. Identified abstracts were independently reviewed and the findings were presented as a narrative summary.

RESULTSOverall, we reviewed 115 articles on an abstract level and retrieved 45 of those as full text articles for background information review and inclusion into the evidence report. Of the articles included in the review, 32% were from United Kingdom (UK). Literature highlights the multi-faceted role of the community pharmacist in disease management. Community pharmacists were involved in the management of asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis and palliative care either alone or in the disease management team. Evidence of effectiveness for community pharmacy/ community pharmacist interventions exists for lipid, diabetes, and hypertension management and for preventive services such as weight management, osteoporosis prevention and fl u immunisation services. Majority of the community pharmacists in Singapore play the traditional role of dispensing. Attempts by the private community pharmacies to provide some professional services were not successful due to lack of funding. Factors found to impede the growth of community pharmacists are insufficient integration of community pharmacist input into healthcare pathways, poor relationship among pharmacists and physicians, lack of access to patient information, time constraints and inadequate compensation.

CONCLUSIONEvidence from observational studies points out the wide range of roles played by the community pharmacist and provides insights into their integration into chronic disease management programmes and health promotion.

Chronic Disease ; Delivery of Health Care ; methods ; organization & administration ; trends ; Disease Management ; Humans ; Internationality ; Patient Care Team ; organization & administration ; Pharmacists ; statistics & numerical data ; Professional Role ; Singapore

Although the genetic basis for bone mineral density (BMD) has been studied by many groups so far, genes responsible for this complex trait has not been completely revealed. In order to localize quantitative trait loci (QTLs) for BMD variation in Asian population, the study was designed using a group of Mongolian population, a genetically closed population with a homogeneous lifestyle. BMD was measured at the left and right wrists and ankles using DEXA in 1,082 participants from 142 families. Genotyping of 13 polymorphic microsatellitemarkers on chromosome 13 (average spacing 8-9 cM) and two-point and multipoint linkage analysis wereperformed. In two-point linkage analysis, we identified two markers, D13S175 (6.03 cM) and D13S265 (68.73cM) that had LOD scores greater than 1 for left ankle (LOD=2.09, LOD=1.49, respectively). We also found a marker D13S175 (6.03 cM) with a high LOD for left wrist (LOD=1.49) and the markers D13S265 (68.73 cM) and D13S217 (17.21 cM) for the right wrist (LOD= 1.82, LOD= 1.62, respectively). Among these significant marker regions, only two regions at 17 cM (13p11) and 65 cM (13q21) for the right wrist overlapped with major QTLs reported in following multipoint linkage analysis (LOD= 1.7549, LOD=1.4462, respectively). This study provides the possible evidence of the presence of QTLs affecting right wrist BMD in Mongolian populations on 13p11 and 13q21. Modest evidence was also found for genes affecting left ankle and left wrist BMD on 13p13.
Animals ; Ankle ; Asian Continental Ancestry Group ; Bone Density ; Chromosomes, Human, Pair 13 ; Humans ; Life Style ; Lod Score ; Morphinans ; Quantitative Trait Loci ; Wrist

INTRODUCTIONOver the years, surveys have become powerful tools for assessing a wide range of outcomes among patients. Healthcare managers and professionals now consider patient satisfaction as an outcome by itself. This study aims to determine if results of a patient satisfaction survey are affected by the manner by which the survey instrument is administered.

MATERIALS AND METHODSA patient satisfaction survey was conducted from May 2006 to October 2007 in a tertiary level acute care facility. All patients admitted to the observation unit during the study period were invited to participate. Using a contextualized version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey, data was collected through either a phone interview, face to face interview or self-administered questionnaire. Each of these survey modes was administered during 3 different phases within the study period.

RESULTSEight hundred thirty-two (832) patients were included in the survey. Based on results of univariate analysis, out of the 18 questions, responses to 11 (61.1%) were related to survey mode. Face-to-face interview resulted in the greatest proportion of socially desirable responses (72.7%), while phone interview yielded the highest proportion of socially undesirable responses (63.3%). After controlling for possible confounders, logistic regression results showed that responses to 55.6% of the questions were affected by survey mode. Variations in response between phone interview and self-administered questionnaire accounted for 87.5% of the observed differences.

CONCLUSIONSResearchers must be aware that the choice of survey method has serious implications on results of patient satisfaction surveys.

Adult ; Emergency Service, Hospital ; Female ; Health Care Surveys ; methods ; Hospitals ; standards ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Patient Satisfaction ; Quality Assurance, Health Care ; Singapore ; Young Adult

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; therapeutic use ; Carcinoma ; epidemiology ; pathology ; radiotherapy ; Disease-Free Survival ; Female ; Humans ; Hypopharyngeal Neoplasms ; epidemiology ; pathology ; radiotherapy ; Hypopharynx ; surgery ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Sex Factors ; Smoking ; epidemiology ; Tumor Burden

OBJECTIVE: This study aims to determine the relationship between the different factors associated with the severity of Fibroscan with CAP findings among patients with Type 2 diabetes and fatty liver.

METHODOLOGY: This is a cross-sectional study. Seven hundred four Fibroscan with Controlled Attenuation Parameter (CAP) results were electronically retrieved from a diagnostic center. Two hundred eighty-five charts of diabetic patients with fatty liver on ultrasound were reviewed. One hundred sixty-four patients with fatty liver on ultrasound and Fibroscan with CAP were included in the study. Several factors were analysed in relation to the severity of Fibroscan with CAP findings in the study group.

RESULTS: Fifty five point five percent (55.5%) (91/164) had significant fibrosis and cirrhosis. Hepatic steatosis prevalence was 96% (158/164). Diabetes >5 years (OR 1.75), HbA1c >7% (OR 2.25) and high SGPT levels (OR 2.39) were associated with liver fibrosis and cirrhosis. BMI >25 kg/m2 (OR 1.45), triglyceride levels >150 mg/dl (OR 1.31) and HbA1c >7% (OR 1.74) were associated with hepatic steatosis.

CONCLUSION: Factors associated with the severity of hepatic fibrosis, cirrhosis and steatosis included above normal BMI, disease duration of >5 years, poor glycemic control and elevated levels of ALT, and serum triglycerides.

Human ; Diabetes Mellitus, Type 2