Over the past two decades, increasing concern and attention have been directed at the potential problems and threats associated with new and emerging diseases. This has been driven by fears arising from the rapid emergence, spread and public health impact of several recent outbreaks, such as the international spread of severe acute respiratory syndrome coronavirus (SARS-CoV) (2003), the potential of avian influenza H5N1 to emerge as a highly lethal pandemic as increasing numbers of human cases are reported (2003 and continuing), and the very rapid global spread of pandemic H1N1 influenza in 2009–2010. The emergence of SARS-CoV, in particular, demonstrated the considerable economic, political and psychological effects–in addition to the impact on public health–of an unexpected epidemic of a highly infectious, previously unknown-agent in a highly connected and interdependent world. These examples clearly highlight the necessity and importance of global outbreak surveillance for the early detection and response to new potential threats. They also demonstrate clearly that these emergent diseases can move rapidly between countries and continents through infected travellers so that surveillance needs to be transparent and authorities made aware of international disease events elsewhere around the globe. Some of the specific threats to the Asian Pacific region have been reviewed elsewhere.

It is now 10 years since the world was faced with the first severe and readily transmissible new disease of the 21st century – severe acute respiratory syndrome (SARS). Unknown and unrecognized, it emerged in late 2002 as the probable cause of an outbreak of atypical pneumonia in Guangdong Province, southern China. It then spread to Hong Kong Special Administrative Region (China) via an infected traveller who arrived at his hotel on 21 February 2003 where he infected 15 other guests. They, in turn, travelled to other countries carrying the new disease and initiating outbreaks in Viet Nam, Singapore and Canada. Three weeks later, with increasing numbers of cases among hospital staff in Hong Kong Special Administrative Region (China) and Viet Nam, the World Health Organization (WHO) issued a global alert on 12 March 2003 about this new acute respiratory syndrome of unknown etiology. However, the disease was spreading rapidly along major air routes, prompting WHO to issue an emergency travel advisory on 15 March, as well as naming the new disease “severe acute respiratory syndrome” and providing the first surveillance case definition.

OBJECTIVE: Since cataract and glaucoma often coexist, and there is no agreement as to their optimal management, a review of the surgical strategies for coexisting I cataract and glaucoma is necessary. The latest evidence-based findings from various studies are presented. METHODS: A literature search of the latest full articles (up to September 2006) was conducted on the surgical management of coexisting cataract and glaucoma. The results of the 2001 Johns Hopkins milestone study were also included for analysis and comparison. RESULTS: Evidence is strong that trabeculectomy is associated with increased risk of postoperative cataract. Though cataract surgery alone may be appropriate for some glaucoma patients, combined cataract and glaucoma surgery lower long-term intraocular pressure (IOP) more than cataract extraction alone. Use of intraoperative mitomycin-C is beneficial in combined surgery. Limbu and fornix-based conjunctival flaps are equally effective for lowering IOP combined surgery. Trabeculectomy alone lowers long-term IOP more tha combined extracapsular cataract extraction (ECCE) and trabeculectomy. Evidence is weak that combined surgery with phacoemulsification rather than ECCE results in lower long-term IOP, as does two-site compared to single-site combined surgery. CONCLUSION: The literature does not point to an optimal strategy for controlling in patients with coexisting cataract and glaucoma needing surgery. There is a continued need for high-quality studies of longer duration and more information on the optic nerve and visual field.
GLAUCOMA ; CATARACT ; INTRAOCULAR PRESSURE ; OCULAR HYPERTENSION ; OCULAR HYPOTENSION ; SURGERY ; PHACOEMULSIFICATION ; TRABECULECTOMY

No abstract available.
Canada* ; Clinical Competence*

OBJECTIVE: This study aims to determine the tumor location of prostate adenocarcinoma in patientswho underwent Robotic Radical Prostatectomy (RRP) for localized and locally-advanced prostatecancer and the correlation of the tumor location with the incidence of biochemical recurrence. PATIENTS AND METHODS: The authors reviewed the patient database of a single Urological Oncologistfrom January 2015 to April 2017 for patients who underwent RRP for localized or locally-advancedprostate cancer. They also reviewed the histopathologic report of the prostatectomy specimens todetermine pathologic T-stage, prostate volume, and post-operative Gleason score. The histopathologicexamination of specimens was interpreted by a single Urological Pathologist based on the 2014International Society of Urological Pathology Gleason Scoring System. Eligible patients were thendivided into three groups: those with pure anterior tumor location, pure posterior tumor location,and mixed tumor location. Presence of positive surgical margins, mean follow-up period, andbiochemical recurrence were determined for these groups. Patient demographic data were analyzedusing test of proportions. Correlation of tumor location with biochemical recurrence was derivedusing Pearson chi-square test. RESULTS: Of the 113 patients included in the study, 63 (55.8%) were clinically-staged T2 patients while27 (23.9%) and 23 (20.3%) were clinical stage T1 and T3, respectively. On pre-operative prostatebiopsy, 27 (23.9%) patients had a Gleason score of 8-10. Thirty-eight (33.6%) and 30 (26.6%) had aGleason score of 6 (3+3) or 7 (3+4), respectively Average prostate volume was 42.8 grams. Ninety-five (84.1%) of the patients had mixed tumor location, 11 (11.6%) had pure posterior tumor location,and only 7 (6.2%) had pure anterior tumor location. In those with pure anterior or posterior tumorlocations, majority were low-grade prostate cancers (Gleason 6(3+3) and Gleason 7(3+4)) whilethose with mixed tumor location had low to high-grade prostate cancers (Gleason 7 (3+4) and Gleason7 (4+3.)) Majority of the patients had pathologic T2c and T3a tumors across all groups. Positivesurgical margins were present in 31% of those with mixed tumor location and only 0.9% in those withpure anterior or posterior tumor location, respectively. Only 10 patients from the population hadbiochemical recurrence, 9 of which had mixed tumor location while 1 had pure posterior tumorlocation. Pearson chi-square test shows no significant relationship between tumor location andbiochemical recurrence at 95% CI (p= regional involvement 0.695.) Furthermore, there is a very weak positive correlation (R=0.069) between tumor location and biochemical recurrence. CONCLUSION Majority of patients who underwent RRP have mixed tumor location. There is poorcorrelation between prostate cancer tumor location and biochemical recurrence.

OBJECTIVE: To determine the proficiency of a single Urological Oncologist in performing RoboticRadical Prostatectomy (RRP) for localized prostate adenocarcinoma based on the following surgicaland functional outcomes: 1) operative time, 2) estimated blood loss, 3) positive surgical margin rate,4) postoperative complication rate, 5) open conversion rate, and 6) urinary continence rate. MATERIALS AND METHODS: The authors reviewed the records of a single Urological Oncologist fromJanuary 2010 to September 2017 for patients who underwent RRP for prostate adenocarcinoma.Patients were divided into 3 groups: Group 1 consisted of the first 30 cases done by the surgeon,Group 2 consisted of the next set of 30 cases, and Group 3 consisted of his cases done thereafter. Themean operative time, mean estimated blood loss, positive surgical margin rate, site of positive surgicalmargins (apex, midgland, or base), postoperative complication rate, open conversion rate, and urinarycontinence rate at 4, 8, and 12 weeks post-op were compared among the 3 groups. RESULTS: A total of 30 patients were included in Group 1, another 30 were included in Group 2, and 45patients were included in Group 3 for a total of 105. There is significant difference in the meanoperative times among the 3 groups with a Group 1 having a mean operative time of 302.1 minutes,170.3 minutes for Group 2, and 146.7 minutes for Group 3 (p<0.0001.) There is a statisticallysignificant difference in mean estimated blood loss among the 3 groups (706.9 mL, 528.2 mL and386.3 mL, respectively; p<0.0001.) No open conversion was performed in all 105 patients and only3 complications were noted in this study. There was no statistical significance with regards to positivesurgical margin rates among the 3 groups (5.7%, 11.4% and 15.2%, respectively.) with the apex beingthe most common site of positive margin in this study. There is a statistically significant difference in8-week urinary continence rate among the 3 groups (12.4%, 20% and 36.2%, respectively; p=0.005). CONCLUSION Robotic Radical Prostatectomy is quickly becoming a feasible and safe option in themanagement of localized and locally-advanced prostate cancer in the local setting. The learningcurve of 30 cases, based on the experiences of the Urological Oncologist, is sufficient in establishingproficiency in performing the said procedure.

Chronic primary glaucoma affects sight very quietly - until such time that the progression of the disease is considerably advanced. The search for the ideal therapeutic approach to the disease can only provide, at best, for the arrest of the damage to the optic nerve head by bringing down the intraocular pressure to a level low enough to elude harm. Patients afflicted with the disease are bound to a therapy of a lifetime. This has implications of understated proportions in the economic scenario of a developing country. This study is conceived to determine the cost-effectiveness of chronic primary glaucoma management. A cross-sectional study design is employed to answer this objective. Medical records of 290 study eyes of 148 patients with chronic primary glaucoma (aged 14 - 88 years) are evaluated for cost-effectiveness of therapy. Results have shown that on one hand, medical therapy has a mean annual cost of PhP 5,830.00 + 278.00. On the other hand, surgical therapy has a one-time mean annual cost of PhP 8,100.00 + 359.00.Comparing cost-effectiveness using analysis of covariance (ANCOVA), one finds that filtering surgery is at least twice more cost effective than medical management (p0.001). Surgical complications, however, may hamper the effectiveness of filtering surgery. The study recommends that young patients with advanced disease and with higher IOP at the time of consult could be served more efficiently with a filter, whereas elderly patients approaching their life expectancy who can comply with the demands of effective medical management may not benefit much from it.
Human ; Aged ; Middle Aged ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY ; FILTERING SURGERY

This study aims to determine the average span of time for Nd:YAG Capsulotomy for posterior capsular opacification after phacoemulsification using four (4) different posterior chamber intraocular lens (IOL) materials (acrylic, polymethylmethacrylate, silicone and hydrogel). This is a retrospective, cohort study wherein data from the charts of 46 patients of a single surgeon were tabulated. All the patients underwent a standardized and an uncomplicated phacoemulsification for senile cataracts with posterior chamber IOL insertion. There were a total of 50 IOLs in this study, 8 acrylic, 16 polymethylmethacrylate (PMMA), 24 silicone and 2 hydrogel. The average duration before Nd: YAG capsulotomy was necessary for each IOL material were: acrylic 11.91 months, PMMA 14.50 months, silicone 18.25 months and hydrogel 8.125 months. This study revealed that each of the four (4) different IOL materials had no influence on the span of time before the necessity for Nd: YAG capsulotomy. (Author)
SURGERY

OBJECTIVE: To determine the efficacy of sequential intravesical Gemcitabine and Docetaxel (siGD) in patients with non-muscle invasive bladder cancer (NMIBC) in preventing disease recurrence after transurethral resection, as an alternative to BCG-naïve patients or to failed intravesical BCG therapy. METHODS: An extensive literature search on the use of siGD for BCG-naïve or BCG-refractory NMIBC was done using the following terms: non-muscle invasive bladder cancer, intravesical Gemcitabine and Docetaxel. Search results were filtered to include all retrospective studies and randomized controlled trials reporting the oncological outcomes of siGD published over the last 5 years from the conception of this study. Information on the safety profile and adverse events related to therapy were also reported, if available. RESULTS: The authors’ search yielded 8 retrospective articles describing the efficacy of siGD for NMIBC, 5 of which had complete and accessible English manuscripts. A total of 476 low to high-risk NMIBC patients were included in the 5 eligible studies, 31 (6.5%) of which were BCG-naïve, while the rest failed BCG therapy. The reported one and two-year success rates were 54-69% and 34-55%, respectively. The recurrence-free survival rates at 1 and 2 years were 49-60% and 29-46%, respectively. Bladder cancer-specific mortality at 1 and 2-years were 1-3% and 4-11%, respectively. Treatment-related adverse reactions were mostly mild, the most common of which were urinary frequency, urgency, hematuria, and dysuria. CONCLUSION Sequential intravesical Gemcitabine and Docetaxel is a feasible alternative for BCG-naïve and BCG-refractory NMIBC patients. Oncological outcomes are comparable to BCG therapy with less adverse effects.

OBJECTIVE: Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate. MATERIALS AND METHODS: This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP. RESULTS: MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%. CONCLUSION The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.