Case Report Open Access 15 Primary sternal osteosarcoma is an exceptionally rare entity with a male preponderance. We report a rare case of a 19 -year-old nulliparous female who presented with a two -year history of a progressively enlarging right breast mass. Multimodality imaging —including chest radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) revealed a large mass arising from the sternum extending into the right breast and anterior mediastinum. Biopsy confirmed high - grade osteosarcoma, characterised by multinucleated giant cells and stromal cells with mild atypia. Immunohistochemistry was positive for vimentin and negative for CK7. Surgical resection was planned; however, the patient declined treatment. This case highlights the importance of considering rare diagnoses in atypical presentations of breast masses and underscores the value of imaging and histopathological correlation in diagnosis and management

Case Report Open Access 15 Primary sternal osteosarcoma is an exceptionally rare entity with a male preponderance. We report a rare case of a 19 -year-old nulliparous female who presented with a two -year history of a progressively enlarging right breast mass. Multimodality imaging —including chest radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) revealed a large mass arising from the sternum extending into the right breast and anterior mediastinum. Biopsy confirmed high - grade osteosarcoma, characterised by multinucleated giant cells and stromal cells with mild atypia. Immunohistochemistry was positive for vimentin and negative for CK7. Surgical resection was planned; however, the patient declined treatment. This case highlights the importance of considering rare diagnoses in atypical presentations of breast masses and underscores the value of imaging and histopathological correlation in diagnosis and management

INTRODUCTION: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Conscious Sedation ; Endoscopy, Gastrointestinal ; Hospitals ; Humans ; Hypnotics and Sedatives ; Singapore

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.
Adalimumab ; Asia ; Asian Continental Ancestry Group ; Biological Factors ; Biosimilar Pharmaceuticals ; Colitis ; Colitis, Ulcerative ; Consensus ; Cooperative Behavior ; Crohn Disease ; Gastroenterology ; Hepatitis B ; Humans ; Immunologic Factors ; Inflammatory Bowel Diseases ; Infliximab ; Pharmacogenetics ; Philippines ; Practice Guidelines as Topic ; Tuberculosis ; Ulcer