OBJECTIVETo evaluate the efficacy and toxicity of concomitant chemo-radiotherapy (CCRT) followed by adjuvant chemotherapy (ACT) in Chinese patients with locoregionally advanced nasopharygeal carcinoma (NPC).

METHODSSeventy-four patients with stage III and IV (UICC1997) were treated by Intergroup 0099 regimen, consisting of CCRT using cisplatin 100 mg/m(2) on D1, 22, and 43 of radiotherapy, followed by ACT using cisplatin 80 mg x m(-2) x d(-1) and 5-Fu 1 g x m(-2) x 4 d(-1) given from D71, 99, and 127. All the patients were irradiated with conventional fractionation to a total dose of 68 Gy to the nasopharynx and 66 Gy to the neck. Acute toxicity and late complication were assessed by the RTOG radiation morbidity scoring scheme.

RESULTSWith a median follow-up of 49 months, the overall 5-year survival and relapse-free survival rates were 71.3% and 43.5% respectively. No grade 5 toxicity was observed in this series, the main grade 3/4 acute toxicity events were hematologic toxicity in 25 patients (33.8%), mucositis in 19 patients (25.7%), and grade 3 skin disease in 6 (8.1%), respectively. The compliance rates were 100.0% for radiotherapy, 75.7% for CCRT, and 47.3% for CCRT plus ACT. The main grade 3/4 late complications were severe salivary gland toxicity (17 cases), ear injury (13 cases), and the neck skin/subcutaneous tissue disease (7 cases). The 5-year cumulative incidence of late toxicity was 44.3%.

CONCLUSIONCompared with routine radiotherapy, the concomitant chemo-radiotherapy may improve the outcome of locoregionally advanced NPC in the Chinese patients, with higher incidence of severe acute toxicities and similar late complications.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Staging ; Radiotherapy ; adverse effects ; Treatment Outcome

We report five cases of non-arteritic anterior ischaemic optic neuropathy (NA-AION) where spontaneous resolution of the optic disc swelling occurred, and all relevant visual modalities were normal at presentation and remained so until resolution of the process after a median time of 9.6 weeks. This condition, which can be termed 'incipient NA‑AION' or 'threatened NA-AION', should be recognised so that unnecessary investigations for other and more serious causes of optic disc swelling can be prevented.
Adrenergic alpha-2 Receptor Agonists ; therapeutic use ; Adult ; Brimonidine Tartrate ; therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Optic Disk ; pathology ; Optic Neuropathy, Ischemic ; diagnosis ; Singapore ; Time Factors ; Vision, Ocular ; Visual Acuity

The personal recovery movement is beginning to gain traction within Singapore's mental healthcare systems. We believe it is timely to give a broad overview of how it developed and provide suggestions on how it can evolve further. From the early custodial care in the 1800s to the community-centric programmes of the 1900s and early 2000s, we now find ourselves at the forefront of yet another paradigm shift towards a more consumer-centric model of care. The following decades will allow personal recovery practitioners and researchers to innovate and identify unique but culturally appropriate care frameworks. We also discuss how the movement can continue to complement existing mental healthcare systems and efforts.
Forecasting ; Humans ; Singapore

In a prospective study, 42 048 adults residing in Zhongshan City, Guangdong, China, were followed for 16 years, and 171 of them developed nasopharyngeal carcinoma (NPC). Although Epstein-Barr virus (EBV) antibody levels of the cohort fluctuated, the antibody levels of 93% of the patients with NPC were raised and maintained at high levels for up to 10 years prior to diagnosis. This suggests that the serologic window affords an opportunity to monitor tumor progression during the preclinical stage of NPC development, facilitating early NPC detection. We reviewed the clinical records of the 171 patients with NPC in the prospective study to assess the efficacy of early NPC detection by serologic screening and clinical examination. Of the 171 patients, 51 had Stage I tumor (44 were among the 73 patients detected by clinical examination and 7 were among the 98 patients presented to outpatient department). Initial serologic screening predicted 58 (95.1%) of the 61 patients detected within 2 years. The risk of the screened population (58/3093) raised 13 times relative to cohort (61/42 048) during this period. Clinical examination detected all the 58 predicted cases, and 35 (60.3%) of which were diagnosed with Stage I tumor. The serologic prediction rate fell to 33.6% (37/110) 2 to 16 years after screening. The proportion of cases detected by clinical examination fell to 40.5% (15/37). The proportion of Stage I tumors among the cases detected by clinical examination during both periods remained at about 60%. We concluded that early detection of NPC can be accomplished by repeated serologic screening to maintain high prediction rates and by promptly examining screened subjects to detect tumors before the symptoms develop.
Adult ; Aged ; Antibodies, Viral ; blood ; Antigens, Viral ; immunology ; Capsid Proteins ; immunology ; Carcinoma, Squamous Cell ; blood ; diagnosis ; pathology ; Chemotherapy, Adjuvant ; Cohort Studies ; Early Detection of Cancer ; methods ; Female ; Herpesvirus 4, Human ; immunology ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; blood ; diagnosis ; pathology ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Remission Induction ; Survival Rate

OBJECTIVES: To report a case of foreign lodged within the sphenoid sinus and its extraction.METHODS:Design: Case report Setting: Tertiary Government Hospital Patient: OneRESULTS: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopy-assisted removal of the foreign body (a glass marble) were performed with no intra-operative and post - operative complications.CONCLUSION:Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.
Human ; Female ; Child ; Sphenoid Sinus ; FOREIGN BODIES ; Tomography Scanners, X-Ray Computed

p style=text-align: justify;strongOBJECTIVE:/strong To determine the mean distance of the main trunk of the facial nerve from two commonly employed surgical landmarks (tragal pointer and tympanomastoid suture line) among a sample a Filipino adults undergoing parotidectomy.METHODS:br /Design:/strong Prospective descriptive studybr /strongSetting: /strongTertiary Government Training Studybr /strongSubjects:/strong 22 patients without facial paralysis undergoing surgery for parotid neoplasms were evaluated intraoperatively.RESULTS/strong: The main trunk of the facial nerve was found to be 9.0 mm (standard deviation of 2.8 mm) from the tragal pointer and 6.1 mm (standard deviation of 2.0 mm) from the tympanomastoid suture line.CONCLUSION/strong: The mean distance from the main trunk of the facial nerve to two of the most commonly utilized landmarks in identification of the nerve during parotidectomy was 9.0 mm (standard deviation of 2.8 mm) from the tragal pointer and 6.1 mm (standard deviation of 2.0 mm) from the tympanomastoid suture line. These may serve as reference values for surgeons in safer identification and preservation of the facial nerve during parotidectomy.
Human ; Male ; Female ; Adult ; Facial Nerve ; Sutures ; Anatomic Landmarks ; body regions

OBJECTIVES: To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without  associated  bleeding, pain,  dysphagia or obstructive sleep  apnea.  Physical  examination revealed  a  pedunculated  mass  about  2  x  1  x  0.5cm  in  size  located  in  the  superior  pole.  After unilateral  tonsillectomy, histopathological  examination  revealed  lymphangectatic  lipomatous fibrotic polyp.
CONCLUSION: Lymphangiomatous polyp of the palatine tonsils  is  an  unusual benign lesion of the head and neck. These  are  commonly  present  as  unilateral,  polypoidal  mass  that  cannot be clinically  differentiated  from  other  benign  tonsillar  lesions. Tonsillectomy  is  the  recommended surgical  approach  for  both  diagnostic  and  therapeutic  purposes.  Histopathological  study  must be done to confirm diagnosis.

Human ; Male ; Adolescent ; Palatine Tonsil ; Hamartoma ; Tonsillectomy ; Lymphangioma ; Deglutition Disorders ; Neck ; Head ; Sleep Apnea, Obstructive ; Polyps ; Pain ; Physical Examination

Overexpression of human epidermal growth factor receptor-2 (HER2) in metastatic breast cancer (MBC) is associated with poor prognosis. This single-arm open-label trial (EGF109491; NCT00508274) was designed to confirm the efficacy and safety of lapatinib in combination with capecitabine in 52 heavily pretreated Chinese patients with HER2-positive MBC. The primary endpoint was clinical benefit rate (CBR). Secondary endpoints included progression-free survival (PFS), time to response (TTR), duration of response (DoR), central nervous system (CNS) as first site of relapse, and safety. The results showed that there were 23 patients with partial responses and 7 patients with stable disease, resulting in a CBR of 57.7%. The median PFS was 6.34 months (95% confidence interval, 4.93-9.82 months). The median TTR and DoR were 4.07 months (range, 0.03-14.78 months) and 6.93 months (range, 1.45-9.72 months), respectively. Thirteen (25.0%) patients had new lesions as disease progression. Among them, 2 (3.8%) patients had CNS disease reported as the first relapse. The most common toxicities were palmar-plantar erythrodysesthesia (59.6%), diarrhea (48.1%), rash (48.1%), hyperbilirubinemia (34.6%), and fatigue (30.8%). Exploratory analyses of oncogenic mutations of PIK3CA suggested that of 38 patients providing a tumor sample, baseline PIK3CA mutation status was not associated with CBR (P = 0.639) or PFS (P = 0.989). These data confirm that the lapatinib plus capecitabine combination is an effective and well-tolerated treatment option for Chinese women with heavily pretreated MBC, irrespective of PIK3CA status.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Asian Continental Ancestry Group ; Breast Neoplasms ; drug therapy ; genetics ; metabolism ; pathology ; Capecitabine ; Class I Phosphatidylinositol 3-Kinases ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Diarrhea ; chemically induced ; Disease Progression ; Disease-Free Survival ; Exanthema ; chemically induced ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; analogs & derivatives ; Hand-Foot Syndrome ; etiology ; Humans ; Middle Aged ; Mutation ; Neoplasm Staging ; Phosphatidylinositol 3-Kinases ; genetics ; Quinazolines ; administration & dosage ; adverse effects ; Receptor, ErbB-2 ; metabolism ; Remission Induction

INTRODUCTIONRemote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network.

METHODSPatients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians.

RESULTSA total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.

CONCLUSIONRemote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.

Aged ; Arrhythmias, Cardiac ; diagnosis ; Defibrillators, Implantable ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Pacemaker, Artificial ; Patient Safety ; Pilot Projects ; Prospective Studies ; Quality of Life ; Remote Consultation ; methods ; Singapore ; Surveys and Questionnaires

BACKGROUND

Musculoskeletal injuries are common in collegiate athletes and can be linked to having elevated levels of kinesiophobia. Kinesiophobia, the fear of re-injury or movement, can be related to an athlete’s self-esteem, as studies have shown that both variables may influence an athlete’s rehabilitation. High athletic identity and low levels of kinesiophobia were seen in athletes who successfully returned to their pre-injury level of competition after rehabilitation. The working theory of this research is if an athlete has an elevated level of kinesiophobia, it decreases one’s self-esteem.

OBJECTIVE

This study aims to determine the association between kinesiophobia and self-esteem among collegiateathletes in Greater Manila who have chronic lower extremity musculoskeletal injuries. The secondary objective of this study is to determine the association of kinesiophobia with demographic variables (sex, sport, and type of injury).

METHODOLOGY

The study will be conducted from January 2023 to April 2024. The researchers will utilize online platforms and/or onsite data collection to disseminate their publication materials and questionnaires. The target participants of this study are collegiate athletes, ages 18-26, representing universities/colleges in Greater Manila, who currently have a lower extremity musculoskeletal injury lasting for 3 months or more and are not receiving physical therapy or other forms of professional treatment. The questionnaire includes the participant’s name, age, sex, university, sport, type of injury, and measuring tools: Tampa Scale of Kinesiophobia, Rosenberg Self-Esteem Scale, and Numerical Pain Rating Scale. The results gathered will be analyzed using the Spearman Correlation Test to associate the variable and the Shapiro-Wilk Test to determine the normality of data.

EXPECTED RESULTS

The results of the study are expected to determine the association between kinesiophobia and self-esteem among collegiate athletes with chronic lower extremity musculoskeletal injuries. The study is also expected to determine if demographic variables such as sex, type of sport, and type of injury are linked to the athletes’ kinesiophobia levels. Thus, this study will aid in establishing the importance of psychological aspects in injury rehabilitation, thereby assisting healthcare professionals in determining the appropriate interventions for an athlete recovering from an injury.

Kinesiophobia