1.Multiple Faces of the Same Pathology
Ng KS ; Fazarina M ; Anizah A ; Shuhaila A ; Yulianty A ; Zainul Rashid MR
Journal of Surgical Academia 2016;6(2):50-54
Ectopic pregnancy is defined as an extrauterine pregnancy. We report three cases where the ectopic pregnancies were
implanted in different sites. The first case was a 28-year-old in her second pregnancy at 9 weeks gestation. She
presented with painless vaginal bleeding. Ultrasound showed unruptured cornual pregnancy with hCG level of
7456mIU/ml. A single dose of 75mg IM methorexate was given and she responded well with significant reduction of
hCG level. The second case, a 26-year-old gravida 5 para 2+2, with 2 previous ectopic pregnancies and bilateral
salpingectomy, conceived via in-vitro fertilization (IVF). She presented with acute abdomen and one episode of
syncope at 8 weeks 4 days gestation. Laparotomy showed ruptured ectopic pregnancy at the left tubal stump
requiring a left salpingectomy. The third case was a 26-year-old, gravida 5 para 2+2, with two previous vaginal
deliveries and two previous first trimester miscarriages. Her menses was irregular since she took injectable progestin.
She presented to the emergency department with sudden onset of lower abdomen pain. Urine pregnancy test was
positive. Ultrasound showed empty uterus, no adnexal mass but there was significant free fluid in the cul-de-sac.
During laparoscopy, a ruptured ovarian pregnancy was diagnosed and salpingo-oophorectomy performed. There was
no significant risk factor contributing to ectopic pregnancy identified in the first and third case. In the second case,
despite previous bilateral salpingectomy, the patient still had ectopic pregnancy in the left fallopian tube remnant.
Pregnancy, Ectopic
2.Learning during the pandemic: Perspectives of medical students in Singapore.
Isaac Ks NG ; Valencia R Y ZHANG ; Fan Shuen TSENG ; Desiree S H TAY ; Shuh Shing LEE ; Tang Ching LAU
Annals of the Academy of Medicine, Singapore 2021;50(8):638-642
The COVID-19 pandemic has significantly disrupted medical education, particularly affecting clinical-year students. Educational institutions often had to halt, shorten or impose significant restrictions on their hospital rotations due to strict infection control and social-distancing guidelines implemented in tertiary healthcare institutions, as well as manpower and logistical constraints amid the pandemic. Thus, distance-based learning platforms such as online lectures and case-based teaching were increasingly adopted in place of bedside and face-to-face tutorials. While interactive virtual case-based discussions are generally useful in imparting clinical reasoning skills to medical students, they are unfortunately not able to fully replicate the experience of clerking, examining and managing real patients in the wards, which is a quintessential process towards building clinical acumen and attaining core clinical competencies. Therefore, for final year medical students who are preparing for their Bachelor of Medicine and Bachelor of Surgery (MBBS) examinations, many are naturally concerned by how learning in this "new normal" may affect their ability to make the transition to become competent junior doctors. As such, we seek to share our learning experiences as the first batch of medical students to have completed our entire final year of clinical education amid the COVID-19 pandemic, and offer 4 practical suggestions to future batches of students on how to adapt and optimise clinical learning under these circumstances: actively engaging in virtual learning, making the most of every clinical encounter, learning how to construct peer teaching/practice sessions, and maintaining physical and psychological well-being.
COVID-19
;
Humans
;
Pandemics
;
SARS-CoV-2
;
Singapore/epidemiology*
;
Students, Medical
3.The Efficacy of Bisphosphonate in the Treatment of Giant Cell Tumour of the Bone: A Systematic Review and MetaAnalysis
Deslivia MF ; Savio SD ; Wiratnaya IGE ; Astawa P ; Sandiwidayat KS ; Bimantara NG
Malaysian Orthopaedic Journal 2023;17(No.1):98-110
Introduction: Anti-osteoclastic mechanism of
Bisphosphonate (BP) is crucial to treat Giant Cell Tumour of
the Bone (GCTB), however no established guidelines of its
use have been published. This systematic review and metaanalysis is the first to summarise recent clinical studies on
the subject.
Materials and methods: A systematic search was
performed based on PRISMA guidelines for clinical trials of
BP administration in GCTB. Baseline data including BP
regimen, dose and timing was summarised. The primary
outcomes assessed were recurrence rate, metastases, survival
rate, functional outcome, clinical outcome, radiological
outcome, and adverse effect.
Results: We identified 8 articles from 2008-2020. Most
studies administer 4mg of Zoledronic acid post-operatively,
with five studies mentioning pre-operative administration
and six studies describing post-operative administration.
There was a total of 181 GCTB cases analysed in this study.
The BP group presented lower recurrence rate than control
group (three studies; Odds Ratio [OR] 0.15; 95% Confidence
Interval [CI], 0.05 – 0.43; p<0.05; heterogeneity, I2=0%). As
for survival rate, BP group is comparable to control group
(two studies; OR 1.67; 95% CI, 0.06 – 48.46; p=0.77;
heterogeneity, I2=65%).
Conclusion: Bisphosphonate therapy offers satisfactory
recurrence rate, functional outcome, clinical outcome,
radiological outcome, survival rate and metastases rate in
patients with GCTB, with minimal adverse effects. Pre- and
post-operative administration of bisphosphonates in
combination might be the most beneficial in minimalising
the recurrence rate.