Subsequent reproduction and obstetric outcome after methotrexate treatment of cervical pregnancy: a review of original literature and international collaborative follow-up

The case reports of 22 patients with cervical pregnancies treated by methotrexate (MTX) administration and published in English literature between 1983 and 1995 were reviewed, by either original paper review or follow-up under international collaboration, to determine the subsequent reproductive performance and obstetric outcomes. Out of 22 cases, 18 (78%) MTX chemotherapy attempts succeeded with complete remission and four (22%) failed. Of the 13 women who wished to conceive and could be followed for at least 3 years, nine succeeded in having live births without congenital malformations, one spontaneously aborted and three suffered infertility. In general, MTX chemotherapy alone or combined with adjuvant methods such as subsequent cervical curettage or cervical tamponade, or intracervical potassium chloride injection, appears to be a convenient and effective method for the treatment of the majority of cervical pregnancies before 12 weeks gestation, and has not been shown to have detrimental effects on subsequent reproductive capacities, obstetric outcomes and progeny health for those cases with successful preservation of the uteri.      

Vulvar basal cell carcinoma: clinical features and treatment outcomes from a tertiary care centre

We retrospectively reviewed the clinical features, management and outcomes of patients diagnosed with basal cell carcinoma (BCC) of the vulva at the Gynaecological Cancer Centre, KK Women’s and Children’s Hospital, Singapore, between 1 January 2000 and 28 February 2014. Patients with vulvar BCC were identified from the cancer registry, and their medical records reviewed and analysed. A total of 11 patients with vulvar BCC were identified. Mean age at diagnosis was 63 (range 30–85) years. Ethnically, ten patients were Chinese and one was Malay. Average time from onset of symptoms to diagnosis was 13.8 (range 2–60) months. The most common presenting symptoms were lump and pruritus. All patients were managed surgically. Recurrence was noted in only one patient. Vulvar BCC, although rare, has an excellent prognosis when managed appropriately. Histological diagnosis of all persistent papules, plaques and pigmented lesions is important for early diagnosis.     

Evaluation of JPEG and JPEG2000 compression algorithms for dermatological images

Background Some image compression methods are used to reduce the disc space needed for the image to store and transmit the image efficiently. JPEG is the most frequently used algorithm of compression in medical systems. JPEG compression can be performed at various qualities. There are many other compression algorithms; among these, JPEG2000 is an appropriate candidate to be used in future. Objective To investigate perceived image quality of JPEG and JPEG2000 in 1 : 20, 1 : 30, 1 : 40 and 1 : 50 compression rates. Methods In total, photographs of 90 patients were taken in dermatology outpatient clinics. For each patient, a set which is composed of eight compressed images and one uncompressed image has been prepared. Images were shown to dermatologists on two separate 17‐inch LCD monitors at the same time, with one as compressed image and the other as uncompressed image. Each dermatologist evaluated 720 image couples in total and defined whether there existed any difference between two images in terms of quality. If there was a difference, they reported the better one. Among four dermatologists, each evaluated 720 image couples in total. Results Quality rates for JPEG compressions 1 : 20, 1 : 30, 1 : 40 and 1 : 50 were 69%, 35%, 10% and 5% respectively. Quality rates for corresponding JPEG2000 compressions were 77%, 67%, 56% and 53% respectively. Conclusion When JPEG and JPEG2000 algorithms were compared, it was observed that JPEG2000 algorithm was more successful than JPEG for all compression rates. However, loss of image quality is recognizable in some of images in all compression rates.     

Visual and auditory evoked responses in acute severe hepatitis

Evoked responses have not been studied in patients with acute severe hepatitis (ASH) with or without hepatic encephalopathy. This prospective study was undertaken to find out diagnostic as well as prognostic value of visual evoked responses (VER), and brain stem auditory evoked responses (BAER) in patients with ASH with or without encephalopathy. Visual evoked responses and BAER were studied in 20 patients (14 males and six females) with ASH. The patients were diagnosed as having severe hepatitis if acute hepatitis was associated with raised serum bilirubin and serum transaminases, and if they had a prothrombin time index of < 50%. After a detailed neuropsychiatric examination of each patient, the study sample was divided into two groups of 10 patients: ASH without encephalopathy (ASH-WOE), and ASH with encephalopathy (fulminant hepatic failure, FHF). The median P100 latencies of FHF patients were significantly increased compared with controls and patients in the ASH-WOE group. Abnormal P100 latencies, exceeding 95th percentile values of the controls, were present in one patient in the ASH-WOE group and six patients in the FHF group. The median interpeak latencies I-III, III-V and I-V were significantly prolonged in the FHF group. Interpeak latencies III-V were also increased significantly in patients in the ASH-WOE group. While abnormal BAER were seen frequently in both groups, VER abnormalities were largely confined to patients in the FHF group. In the FHF group, six out of 10 patients survived and exhibited clinical improvement in the status of hepatic encephalopathy. Evoked responses were repeated after 2–3 weeks of recovery in these patients and VER abnormalities showed a tendency to normalize, thereby suggesting a prognostic implication. The incidence of abnormal VER in hepatic encephalopathy complicating ASH far exceeded that of abnormal BAER. Markedly prolonged P100 latencies in FHF patients indicate poor prognosis.     

The effectiveness of a shared conference experience in improving undergraduate medical and nursing students’ attitudes towards inter-professional education in an Asian country: a before and after study

Background

In recent years, increasing emphasis has been placed on the importance of collaboration within multi-disciplinary healthcare teams, so as to facilitate holistic patient care and thus allow improved treatment outcomes. There is hence an urgent need to educate healthcare undergraduates early in their professional careers on the importance of and complexities involved in cooperating with counterparts from other allied healthcare professions. In conjunction with this, a milestone student-led conference for undergraduate students, the 9th Student Medical-Nursing Education Conference (SMEC), was organised in 2013 to provide a unique opportunity for shared learning among the entire cohort of undergraduate medical and nursing students in Singapore matriculating in that year.

Methods

This study evaluated the effectiveness of the 9th SMEC 2013 as a shared conference experience in improving the attitudes of undergraduate medical and nursing students in Singapore towards inter-professional education (IPE). A 19-point Readiness for Inter-Professional Learning Scale (RIPLS) questionnaire comprising three subscales was administered to participants both before and after the conference. 352 responses were collected, giving a response rate of 75.1 %. Results were analysed using paired-samples t-tests with statistical significance set at p?=?0.05.

Results

Improvements in overall scores for both medical and nursing students were reported for all three RIPLS subscales. Examining the RIPLS items individually, significant improvement in scores for both medical and nursing students was obtained in all 19 items. Prior exposure to IPE activities was not a predictor of improvement in IPE attitudes.

Conclusion

The authors propose that student-led jointly-organised conference experiences are effective in improving healthcare students’ attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to allow for the rapid and effective promotion of cooperation and collaboration between students across various healthcare disciplines.

     

Expression of intercellular adhesive molecule1 in liver cancer tissues and liver cancer metastasis

AIM: To study the relationship between intercellular adhesive molecule-1 (ICAM-1) and liver cancer metastasis and to search for factors to predict metastasis of liver cancer.METHODS: ICAM-1 expression in fresh tissues of normal liver and hepatocellular cancer (HCC) was examined by immunoperoxidase staining. The expression of ICAM-1 in human hepatoma, tumor surrounding tissues and normal livers were semiquantitatively analyzed by Dot immuno blot. Tissue ICAM-1 expression at mRNA level was detected by Northern blot.RESULTS: All 6 cases of normal liver samples were negative in anti-ICAM-1 immunohistochemical staining, 80.0% (36/45) of HCC presented various ICAM-1 expression. The number of positive cells was a little higher in large tumors, tumors with intact capsule and metastasis, but there was no significant difference. Two cases with cancer embolus also had high ICAM-1 expression. ICAM-1 concentration in HCC (13.43 ± 0.09) was higher than that in tumor surrounding tissues (5.89 ± 0.17, P < 0.01) and normal livers (4.27 ± 0.21, P < 0.01). It was also higher in metastasis group (20.24 ± 0.30) than in nonmetastasis group (10.23 ± 0.12, P < 0.05). Northern blot analysis revealed that ICAM-1 expression at mRNA level was also higher in HCC and cancer embolus than that in tumor surrounding tissues and normal livers.CONCLUSION: Tissue ICAM-1 could indicate the growth and metastasis of HCC, and may be an index that can predict liver cancer metastasis.     

Mode of Detection of HIV Infection – A Retrospective Study of 612 Cases

Background

Trends in mode of detection of HIV infection in the Armed Forces required to be analyzed to formulate future strategies for early detection.

Methods

A retrospective study was thus conducted in 612 newly diagnosed HIV-positive cases between January 1997 to August 2002.

Results

182(29.74%) patients had already developed Category C conditions when detected to be HIV-positive, 176(96.70%) with mycobacterial disease, majority (67.61%) of them being pulmonary tuberculosis, followed by recurrent bacterial pneumonia in 3 (1.65%), pneumocystis carinii pneumonia (PCP) in 2(1.1%) and oesophageal candidiasis in one (0.55%). Herpes zoster was the third most common mode of detection accounting for 86 (14.05%) of the cases (24.6% of them with involvement of ophthalmic branch of trigeminal nerve), after tuberculosis in 176(28.76%) and blood donors in 98(16.01%), followed by constitutional symptoms in 59(9.64%) cases, investigation for STDs in 56(9.15%), bacterial pneumonia in 6(0.98%) and oral mucosal candidiasis in only one (0.16%) case. None was detected during acute retroviral illness and only 5(0.82%) cases were detected while being investigated for generalized lymphadenopathy. Amongst the cases detected during investigation for STDs, majority (26.79%) were on STD surveillance. 22(3.60%) cases tested positive when their spouses were detected to be HIV-positive, 20(3.27%) while being screened for surgery, 4(0.65%) for posting abroad and 2(0.32%) each during investigation when child was found HIV-positive and investigation for HBV infection. Remaining 69(11.27%) patients were detected during investigation of various related or unrelated conditions including one (0.16%), which reported voluntarily after a high-risk exposure.

Conclusion

There is a need to encourage voluntary reporting and identify more number of cases during acute retroviral syndrome and PGL stage.Key Words: HIV infection, Mode of detection     

Combination of short CAG and GGN repeats in the androgen receptor gene is associated with acne risk in North East China

Background Acne vulgaris is one of the most common skin disorders, and androgen is known to play a key role in the development of acne. However, the exact genetic mechanism by which androgen receptor (AR) gene affects acne development is still unclear. Objective Our study aimed to investigate whether CAG and GGN polymorphism of the AR gene are associated with acne risk. Patients and methods Two hundred thirty‐eight patients and 207 controls were included in the study. The repeat lengths of the AR gene were determined by GeneScan analysis. Results Men with CAG < 23 and women with CAG < 24 had significant risk compared to those men with CAG ≥ 23 [odds ratio (OR), 2.07; 95% confidence interval (95% CI), 1.21–3.54] and women with CAG ≥ 24 (OR, 2.05; 95% CI, 1.18–3.56). In males, GGN repeats, considered independently of the CAG repeat, have no significant effect on the acne risk; however, when combined with CAG repeats, the acne patients exhibited significantly higher frequency of the haplotypes CAG < 23/GGN ≤ 23 (OR, 3.33; 95% CI, 1.10–10.07; P < 0.05) compared with the controls. Conclusion Our results of this study strongly indicated that a shorter CAG repeat length and specific haplotypes of AR attributed to the risk of acne development and thus could serve as a susceptibility marker.