INTRODUCTION

Eosinophilic Granulomatosis Polyangiitis (EGPA) is the rarest among the ANCA-associated vasculitis with an incidence of seven per million individuals. Cardiac involvement occurs in 15-60% of patients and is the most severe manifestation associated with poor prognosis and mortality. EGPA typically affects the left side of the heart. There is only one published study to date that describes a case of right sided heart failure from pulmonary arterial hypertension.

A 40-year-old, Filipino, female, complained of rash, wheezing and right sided heart failure symptoms. After a thorough work-up, she was managed as a case of EGPA based on palpable, erythematous, nonpruritic rash on the lower extremities, peripheral eosinophilia (54%), adult-onset asthma, mononeuritis multiplex, cardiac symptoms, (+) p-ANCA and leukocytoclastic vasculitis with eosinophils and early granuloma formation on skin punch biopsy. The 2D-echocardiography showed an elevated estimated pulmonary pressure with signs of right sided volume overload. Chest computed tomography with contrast revealed right atrial and biventricular enlargement, hepatomegaly and unremarkable pulmonary findings. Methylprednisolone along with intravenous cyclophosphamide pulse therapy were initiated which resulted in the resolution of symptoms with normalization of blood eosinophils. Repeat 2D-echocardiogram had unremarkable findings as well. With the improvement noted, she was then maintained on glucocorticoids and mycophenolate mofetil.

Although EGPA commonly presents with symptoms of asthma, rhinosinusitis and/or peripheral eosinophilia, one uncommon presentation would be cardiac manifestations, specifically progressive pulmonary arterial hypertension with subsequent right sided heart failure. High dose glucocorticoids along with other immunosuppressants such as cyclophosphamide, are the treatment options in managing life-threatening conditions. Early detection is crucial in the prevention of grave outcomes.

OBJECTIVE

This study compared the demographics, clinical profile, treatment, and outcomes of retinoblastoma patients seen at medical institutions in the Philippines between two time periods: 2010 to 2015 and 2016 to 2020.

This was a multicenter, analytical, cohort study using review of medical charts and databases of retinoblastoma patients seen in 11 medical institutions from 2010 to 2020.

There were 636 patients (821 eyes) included in this study: 330 patients were seen in 2010 to 2015 while 306 in 2016 to 2020. More cases per annum were seen in the latter timeline. The number of patients with unilateral disease was not significantly different between the two time periods (p=0.51). Age at onset of symptom, age at initial consultation, and delay in consult were also not significantly different between the two time periods (p > 0.05). Patients had significantly different distributions of intraocular grades (p < 0.0001) and systemic staging (p < 0.0001) between the two time periods. Enucleation was the most common surgical treatment performed in both timelines. There was significant difference in the status of patients based on the need for systemic chemotherapy (p < 0.01). There was significant difference in outcome between the two time periods, including the proportions of living and deceased patients.

This study compared the most comprehensive data on retinoblastoma patients in the country. There was no improvement in early health seeking behavior based on similar age at initial consult and delay in consult. Enucleation remained the most common treatment mode as opposed to chemotherapy due to similar percentage of patients with unilateral disease, an indication for enucleation rather than chemotherapy.

INTRODUCTION: Singapore's enhanced surveillance programme for COVID-19 identifies and isolates hospitalised patients with acute respiratory symptoms to prevent nosocomial spread. We developed risk prediction models to identify patients with low risk for COVID-19 from this cohort of hospitalised patients with acute respiratory symptoms. METHODS: This was a single-centre retrospective observational study. Patients admitted to our institution's respiratory surveillance wards from 10 February to 30 April 2020 contributed data for analysis. Prediction models for COVID-19 were derived from a training cohort using variables based on demographics, clinical symptoms, exposure risks and blood investigations fitted into logistic regression models. The derived prediction models were subsequently validated on a test cohort. RESULTS: Of the 1,228 patients analysed, 52 (4.2%) were diagnosed with COVID-19. Two prediction models were derived, the first based on age, presence of sore throat, dormitory residence, blood haemoglobin level (Hb), and total white blood cell counts (TW), and the second based on presence of headache, contact with infective patients, Hb and TW. Both models had good diagnostic performance with areas under the receiver operating characteristic curve of 0.934 and 0.866, respectively. Risk score cut-offs of 0.6 for Model 1 and 0.2 for Model 2 had 100% sensitivity, allowing identification of patients with low risk for COVID-19. Limiting COVID-19 screening to only elevated-risk patients reduced the number of isolation days for surveillance patients by up to 41.7% and COVID-19 swab testing by up to 41.0%. CONCLUSION Prediction models derived from our study were able to identify patients at low risk for COVID-19 and rationalise resource utilisation.
Humans ; COVID-19/epidemiology* ; SARS-CoV-2 ; Hospitalization ; Logistic Models ; Retrospective Studies ; Hemoglobins

Antibodies, Viral ; Antibody Formation ; BNT162 Vaccine ; COVID-19/prevention & control* ; Female ; Humans ; Milk, Human ; Pilot Projects ; RNA, Messenger ; Vaccination

Russell bodies (RB) are rare manifestations within the lower gastrointestinal tract. To date, there are only three other reported cases of RB lesions of the colon; two were polyps, and the third was a case of a multifocal RB lesion of the gastrointestinal tract. This paper reports a case of a tubulovillous adenoma with RB of the sigmoid colon in a patient diagnosed incidentally as part of the UK National Health Service Bowel Cancer Screening Programme. A thorough hematological investigation is required to exclude hematological malignancies because of its association with plasma cell neoplasm. These lesions should undergo clonality analysis to exclude the monoclonal proliferation of plasma cells. Ideally, a bone marrow aspirate and investigations for amyloidosis should be performed to exclude underlying hematological malignancies.

Russell bodies (RB) are rare manifestations within the lower gastrointestinal tract. To date, there are only three other reported cases of RB lesions of the colon; two were polyps, and the third was a case of a multifocal RB lesion of the gastrointestinal tract. This paper reports a case of a tubulovillous adenoma with RB of the sigmoid colon in a patient diagnosed incidentally as part of the UK National Health Service Bowel Cancer Screening Programme. A thorough hematological investigation is required to exclude hematological malignancies because of its association with plasma cell neoplasm. These lesions should undergo clonality analysis to exclude the monoclonal proliferation of plasma cells. Ideally, a bone marrow aspirate and investigations for amyloidosis should be performed to exclude underlying hematological malignancies.

Background: Social media is a common channel for communication, information and education. However, it is also a potential forum where lapses of professionalism may occur. In this study we aimed to elicit medical students’ perspective on social media practices and their perceived implications of social media posts. Methods: We conducted a cross-sectional study of Semesters 1 and 9 medical students from the International Medical University (IMU). A score was created consisting of the sum of the Likert scale in the 10-item social media practices questionnaire. Categorical variables were compared using chi-square test, while continuous variables that were not normally distributed were compared using Mann-Whitney U test. Statistical significance was set at p<0.05. Results: Out of 118 respondents (61% females), 54.2% of them recalled previous instructions regarding the use of social media and 55.1% of them were familiar with the IMU Social Media Guidelines. In general, respondents showed high level of awareness of inappropriate social medial practices, with statistically better awareness among Semester 1 students. Students who reported familiarity with IMU Social Media Guidelines were more aware of inappropriate social media practices. Most respondents were aware of the potential adverse impact of social media posts. Conclusion IMU students who participated in our survey generally had a good grasp of what constitutes inappropriate behaviour on social media and its potential future impact. Lower level of awareness of inappropriate social media practices among the Semester 9 students points to the need for periodic reminders of IMU Social Media Guidelines.
Students, Medical ; Social Media ; Professionalism ; Ethics, Medical

Aged ; Cholecystectomy, Laparoscopic ; methods ; Cholelithiasis ; complications ; diagnosis ; surgery ; Clinical Laboratory Techniques ; Coronavirus Infections ; complications ; diagnosis ; Elective Surgical Procedures ; methods ; Follow-Up Studies ; Humans ; Infection Control ; methods ; Male ; Pandemics ; Patient Safety ; Pneumonia, Viral ; complications ; diagnosis ; Postoperative Care ; methods ; Risk Assessment ; Singapore ; Treatment Outcome