3.Factors influencing late stage of breast cancer at presentation in a district Hospital - Segamat Hospital, Johor
Mao Li Cheng ; BCh BAO, DaoYao Ling ; Prathibha K P Nanu ; Hasnizal Nording ; Chen Hong Lim
The Medical Journal of Malaysia 2015;70(3):148-152
Introduction: In Malaysia, late stage presentation of breast
cancer (stage III or IV) has been a healthcare problem that
varies geographically throughout the country. This study
aims to understand the factors influencing late stage of
breast cancer at presentation among Malaysian women in
Segamat Hospital, Johor, which is a district hospital.
Methods: A retrospective descriptive study was conducted
on secondary data of all newly diagnosed breast cancer
women from 1st August 2011 to 28th February 2014.
Secondary data includes age, ethnicity, marital status, family
history, education level, occupation, presenting symptom,
duration of symptom, tumour size, tumour pathology,
tumour grading, oestrogen, progesterone and HER-2
receptor status were collected and analysed using SPSS
version 20.0.0.
Result: In total, data from 52 women was analysed and two
women were excluded for incompleteness as these women
defaulted. Late stage at presentation was 59.6% of all new
cases (17.3%, stage III and 42.3%, stage IV). The commonest
age group of all women diagnosed with breast cancer was in
the 5th decade. Majority of them were Malay, married and
housewives with no family history of breast cancer. The
statistically significant factors associated with late stage at
presentation include Malay ethnicity (p=0.019), presenting
symptoms other than breast lump (p=0.047), and duration of
breast lump more than 3 months (p=0.009).
Discussion/Conclusion: The study demonstrated presentation
at late stage of breast cancer is a major health concern
among Malaysian women in district hospital. This may be
attributed to different sociocultural beliefs, strong belief in
complementary and alternative medicine, lack of awareness,
and difficult accessibility to healthcare services.
Breast Neoplasms
4.Diffusion-weighted magnetic resonance imaging in a case of osmotic demyelination syndrome with fatal outcome
Shen-Yang Lim ; ,Ismaliza Ismail ; Sharon Mei-Ling Tai ; Khairul Azmi Abdul Kadir ; Li-Ping Tan ; Yip-Boon Chong ; Nortina Shahrizaila
Neurology Asia 2011;16(1):89-92
Hyponatraemia with rapid correction of serum sodium may cause an osmotic demyelination syndrome
(ODS) with damage to pontine and/or extrapontine areas of the brain. The prognosis of ODS can range
from complete recovery to death; at present, our ability to predict clinical outcome is very limited. We
describe here a patient with ODS and increased signal intensity in the striatum on diffusion-weighted
MRI, with corresponding low apparent diffusion coeffi cient values (indicating restricted water diffusion).
This case provides a further example of the typical MRI appearance of extrapontine ODS and suggests
the potential value of diffusion-weighted MRI in predicting prognosis in ODS.
5.Obstructive sleep apnoea in Singapore: polysomnography data from a tertiary sleep disorders unit.
Li Ling LIM ; Kwang Wei THAM ; Stephanie M C FOOK-CHONG
Annals of the Academy of Medicine, Singapore 2008;37(8):629-636
INTRODUCTIONComprehensive sleep architecture and respiratory event data in local patients with suspected obstructive sleep apnoea (OSA) from overnight polysomnography (PSG), the gold standard for the evaluation of sleep-related breathing disorders, are not widely available. We present 1 year retrospective PSG data with the objective of describing PSG characteristics of patients evaluated for OSA in Singapore.
MATERIALS AND METHODSPSG data of patients evaluated for OSA in 1 year (January through December 2005) in the Sleep Laboratory of a public tertiary hospital were retrospectively reviewed.
RESULTSFive hundred and eighty-four diagnostic PSG studies were performed in patients with symptoms suggestive of sleep-disordered breathing, including snoring, excessive daytime sleepiness, unrefreshing sleep, or recurrent unexplained awakenings. There were 449 male patients (76.9%) and 135 female patients (23.1%), with a mean age of 47.5 years (SD 12.7). Men were on average younger than women, 46.1 years versus 52.0 years (P <0.0005). The mean body mass index (BMI) was 27.9 (SD 6.7), with no significant difference between genders. An association was shown between apnoea-hypopnoea index (AHI) and BMI (Pearson correlation index r = 0.362). Men had overall significantly higher AHI (16.5 vs 9), shorter mean sleep onset latency (11 vs 16.5 minutes), more light sleep (65.5% vs 58.9%), less deep sleep (17.7% vs 23%), and more respiratory event related arousals per hour of sleep (11.6 vs 5.1) (P <0.0005). Severity was classified: AHI <5 ("Normal Overall AHI") (28.3%), AHI 5-15 ("Mild") (22.3%), AHI >15-30 ("Moderate") (18.3%), AHI >30 ("Severe") (31.2%). There was no significant age difference among the 4 groups. More severe OSA patients were significantly heavier, and had more light sleep, less deep sleep, less REM sleep, more respiratory event related arousals and lower levels of oxygen desaturation.
CONCLUSIONOSA is predominant in middle-aged, overweight Singapore males and much less common in females who tend to be older. A majority of patients have moderate to severe OSA, which significantly disturbs normal sleep architecture. The relatively lower BMI compared to Caucasian OSA populations may be related to local craniofacial characteristics and/or higher percentage of body fat for BMI which has been described in Singaporeans.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Obesity ; epidemiology ; Polysomnography ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Sleep Apnea, Obstructive ; diagnosis ; epidemiology ; physiopathology
6.Validation of the Paediatric Hearing Impairment Caregiver Experience (PHICE) Questionnaire.
Lynne H Y LIM ; Ling XIANG ; Naomi L Y WONG ; Kevin C P YUEN ; Ruijie LI
Annals of the Academy of Medicine, Singapore 2014;43(7):362-370
INTRODUCTIONThe paediatric hearing impairment caregiver experience (PHICE) questionnaire is a 68-item instrument that assesses the stress experienced by caregivers of children with hearing impairment (HI). While the questionnaire has been validated in the United States, it may need to be modified for use in the Singapore context due to the differing healthcare system, costing and culture related to caregiving for children with HI. This study aims to modify and validate the PHICE questionnaire to increase its relevance and ease of use in Singapore.
MATERIALS AND METHODSThe original PHICE questionnaire was filled out by 127 caregivers of HI children managed at the otolaryngology clinic of the National University Hospital (NUH). An expert panel was convened to assess the questionnaire for its suitability for use in Singapore. Exploratory factor analysis was conducted to evaluate the underlying factor structure of the original PHICE questionnaire. Items with high cross-loadings were removed and a new factor structure was adopted which was further analysed using confirmatory factor analysis (CFA). Cronbach's alpha (α) was computed to determine the internal consistency of the new subscales.
RESULTSItems that are less relevant in Singapore and those with high cross-loadings were removed. A 5-factor structure with only 42 items remaining and corresponding to the factors: " Policy", "Healthcare", "Education", "Support" and "Adaptation" was adopted. CFA suggests a good model fit for the modified questionnaire, improved from the 8-factor structure of the original PHICE. Cronbach's α were high (>0.7) for each new subscale.
CONCLUSIONThe original PHICE questionnaire has been shortened and reorganised in terms of the subscales composition. The resulting instrument is structurally valid and internally consistent. It is a simple and useful tool for identifying factors related to caregiving that can negatively impact rehabilitation outcomes for children with HI in Singapore. Removal of some sign language items makes this modified version less useful for caregivers, places or countries where sign language is the main focus of rehabilitation for children with HI.
Adolescent ; Caregivers ; Child ; Child, Preschool ; Female ; Hearing Loss ; therapy ; Humans ; Infant ; Infant, Newborn ; Male ; Singapore ; Surveys and Questionnaires
7.A Survey on Singaporean Women's Knowledge, Perception and Practices of Mammogram Screening.
Siew Kuan LIM ; Xin Ling TEO ; Jia Lin NG ; Fay X LI ; Su Ming TAN
Annals of the Academy of Medicine, Singapore 2015;44(9):317-325
INTRODUCTIONSingapore is the first Asian country to establish a nationwide breast screening programme, but our breast cancer screening uptake lags behind the Western countries. This survey focused on the subject of screening mammography, to assess the reasons for non-attendance and explore ways to improve our screening uptake.
MATERIALS AND METHODSFemales ≥21 years old were approached at primary healthcare clinics to participate in this survey, which questioned their knowledge, perception and expectations of breast screening.
RESULTSThere were 1011 respondents. Of the 740 respondents ≥40 years old, 332 respondents (45.5%) went for regular mammogram screening. Women who had lower household incomes [<$2000 (OR 0.49; 95% CI, 0.28 to 0.85); $2000 to $3999 (OR 0.59; 95% CI, 0.36 to 0.97)], did not know anyone with breast cancer (OR 0.62; 95% CI, 0.42 to 0.92), did not perform breast self-examination (OR 0.42; 95% CI, 0.28 to 0.62), had lower knowledge scores (OR 0.34; 95% CI 0.22 to 0.51), did not attend other health screening (OR 0.14; 95% CI, 0.05 to 0.41), and perceived mammography as embarrassing (OR 0.55; 95% CI, 0.31 to 0.96), were less likely to attend mammographic screening. Many did not know that screening is for the asymptomatic (51.2%), or the age to start screening (46.3%). Most respondents preferred to have their mammograms in the polyclinics (62.2%) and their screening reminders to be through short messaging service (SMS) (46.0%).
CONCLUSIONOur results show the current influences on Singapore women's screening practices, and also revealed that their understanding of mammogram screening is limited despite a high level of breast cancer awareness.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; diagnosis ; diagnostic imaging ; Breast Self-Examination ; Early Detection of Cancer ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Mammography ; Middle Aged ; Patient Acceptance of Health Care ; Singapore ; Surveys and Questionnaires ; Young Adult
8.Abnormal p53 expression is associated with poor outcomes in grade I or II, stage I, endometrioid carcinoma:a retrospective single-institute study
Yu-Wei CHANG ; Hsiao-Li KUO ; Tzu-Chien CHEN ; Jessica CHEN ; Ling LIM ; Kung-Liahng WANG ; Jen-Ruei CHEN
Journal of Gynecologic Oncology 2024;35(6):e78-
Objective:
The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC).
Methods:
We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups.
Results:
Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend.
Conclusion
For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.
9.Abnormal p53 expression is associated with poor outcomes in grade I or II, stage I, endometrioid carcinoma:a retrospective single-institute study
Yu-Wei CHANG ; Hsiao-Li KUO ; Tzu-Chien CHEN ; Jessica CHEN ; Ling LIM ; Kung-Liahng WANG ; Jen-Ruei CHEN
Journal of Gynecologic Oncology 2024;35(6):e78-
Objective:
The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC).
Methods:
We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups.
Results:
Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend.
Conclusion
For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.
10.Abnormal p53 expression is associated with poor outcomes in grade I or II, stage I, endometrioid carcinoma:a retrospective single-institute study
Yu-Wei CHANG ; Hsiao-Li KUO ; Tzu-Chien CHEN ; Jessica CHEN ; Ling LIM ; Kung-Liahng WANG ; Jen-Ruei CHEN
Journal of Gynecologic Oncology 2024;35(6):e78-
Objective:
The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC).
Methods:
We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups.
Results:
Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend.
Conclusion
For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.