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Background and Objective@#Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this. @*Methods@#This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines. @*Results@#The UP-PGH CRC KAP (University of the Philippines – Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire’s validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively).Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense. @*Conclusion@#The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.
Subject(s)
Knowledge , AttitudeABSTRACT
Background/Aims@#Performance of diagnostic or therapeutic endoscopic procedures in inflammatory bowel disease (IBD) patients can be challenging during a viral pandemic; the main concerns being the safety and protection of patients and health care providers (HCP). The aim of this study is to identify endoscopic practice patterns and outcomes of IBD and coronavirus disease 19 (COVID-19) with a worldwide survey of HCP. @*Methods@#The 20-item survey questionnaire was sent to physician members of the American Society for Gastrointestinal Endoscopy Special Interest Group in Interventional IBD, Chinese IBD Society Endoscopy Interest Group, and the China Crohn’s and Colitis Foundation. @*Results@#A total of 141 respondents submitted valid responses. Nighty-five respondents (67.9%) reported that at least 25% of their scheduled emergent endoscopic procedures were canceled or postponed during the pandemic. Fifty-six respondents (40.0%) have performed emergent endoscopy during the pandemic. A few respondents (9/140, 6.4%) estimated that more than 25% of their patients had worsened disease due to delayed or canceled emergent endoscopy procedures. More than 80% of respondents believed that personal protective equipment (PPE) for the endoscopy team, room sterilization, and pre-procedure screening of patients for COVID-19 were necessary. Out of 140 respondents, 16 (11.4%) reported that several of their patients had COVID-19. Eight clinicians (5.7%) reported that they or their endoscopy colleagues developed work-related COVID-19. @*Conclusions@#Cancellation of elective and emergent endoscopy in IBD care during the pandemic was common. Few respondents reported that their patients’ disease conditions worsened due to the cancellation of the endoscopy procedure. Most respondents voiced the need for proper PPE during the procedure regardless of patients’ COVID-19 status and screening the patients for COVID-19.
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Background/Aims@#Performance of diagnostic or therapeutic endoscopic procedures in inflammatory bowel disease (IBD) patients can be challenging during a viral pandemic; the main concerns being the safety and protection of patients and health care providers (HCP). The aim of this study is to identify endoscopic practice patterns and outcomes of IBD and coronavirus disease 19 (COVID-19) with a worldwide survey of HCP. @*Methods@#The 20-item survey questionnaire was sent to physician members of the American Society for Gastrointestinal Endoscopy Special Interest Group in Interventional IBD, Chinese IBD Society Endoscopy Interest Group, and the China Crohn’s and Colitis Foundation. @*Results@#A total of 141 respondents submitted valid responses. Nighty-five respondents (67.9%) reported that at least 25% of their scheduled emergent endoscopic procedures were canceled or postponed during the pandemic. Fifty-six respondents (40.0%) have performed emergent endoscopy during the pandemic. A few respondents (9/140, 6.4%) estimated that more than 25% of their patients had worsened disease due to delayed or canceled emergent endoscopy procedures. More than 80% of respondents believed that personal protective equipment (PPE) for the endoscopy team, room sterilization, and pre-procedure screening of patients for COVID-19 were necessary. Out of 140 respondents, 16 (11.4%) reported that several of their patients had COVID-19. Eight clinicians (5.7%) reported that they or their endoscopy colleagues developed work-related COVID-19. @*Conclusions@#Cancellation of elective and emergent endoscopy in IBD care during the pandemic was common. Few respondents reported that their patients’ disease conditions worsened due to the cancellation of the endoscopy procedure. Most respondents voiced the need for proper PPE during the procedure regardless of patients’ COVID-19 status and screening the patients for COVID-19.
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Background: Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services. Setting: Offinso North, Amansie West, Ahafo Ano South, and Asante Akim South. Methods: A population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents. Results: A total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.61%. The public hospital was the most preferred choice of facility (52.56%) for patients with NCDs. Educational level significantly decreased the likelihood of seeking healthcare in OTCMS and Health Centre to Hospitals (RRR = 0.1, 95% CI = 0.0110.917, p = 0.042) and (RRR = 0.4, 95% CI = 0.198-0.679, p = 0.001) respectively. Conclusion: The prevalence of self -reported hypertension and diabetes observed in this study was relatively lower for hypertension and higher for diabetes as compared to other studies in Ghana. The public hospital is the most preferred choice of health facilities for patients with hypertension and diabetes in the rural districts
Subject(s)
Delivery of Health Care , Diabetes Mellitus , Ghana , Hypertension , Noncommunicable Diseases , Patients , Rural Health ServicesABSTRACT
INTRODUCTION@#Chronically-ill patients are known to pose an impact on the family function (FF) and quality of life (QoL) of their family caregivers and pediatric siblings. However, there is limited literature on the relationship between FF and QoL. This study aimed to determine the correlation of FF and QoL among healthy young adults with siblings with chronic diseases. @*METHODS@#This was an analytical cross-sectional study among young adults, selected by purposive sampling, with chronically-ill siblings. The CAPGAR and WHOQOL-BREF questionnaires were used for data collection. Spearman’s correlation coefficient r was used to determine the correlation between FF and QoL.@*RESULTS@#More than half (53.9%) of the respondents had highly functional families. Majority of the participants (66.5%) had fair QoL. There was a weak but significant positive correlation (r = 0.27, p < 0.001) between FF and QoL.@*CONCLUSION@#There is a weak but significant positive correlation between family function and quality of life among healthy young adults with a sibling suffering from a chronic debilitating illness.
Subject(s)
Quality of Life , SiblingsABSTRACT
Objective@#The study aims to determine the factors associated with unsuccessful treatment outcome among patients who have undergone tuberculosis treatment.@*Methods@#An analytic cross-sectional study was employed through secondary data analysis of administrative data collected by the National Tuberculosis Control Program from October 2015 to September 2016. Using multiple logistic regression analysis, factors associated with unsuccessful treatment outcome were determined. @*Results@#Multiple logistic regression analysis revealed that belonging to age groups 25 to 34 (aOR=0.73; 95%CI 0.54-0.99) or 35 to 44 (aOR=0.75; 95%CI 0.56-0.99), being male (aOR=1.30; 95%CI 1.03-1.64), doing crafts and related trades work (aOR=0.66; 95%CI 0.46-0.94), living in either a 4th class city (aOR=0.46; 95%CI 0.26-0.82), 1st class municipality (aOR=0.75; 95%CI 0.57-0.98), 4th class municipality (aOR=0.59; 95%CI 0.38-0.93), having a positive sputum smear result (aOR=1.60; 95%CI 1.29-2.00), having rifampicin-resistant/ multidrug-resistant tuberculosis (aOR=9.32; 95%CI 7.28-11.93), being a treatment after lost to follow-up case (aOR=1.84; 95%CI 1.37-2.47) or a case with previously unknown treatment outcome (aOR=1.42; 95%CI 1.00-2.01) were significant correlates of unsuccessful treatment outcome. @*Conclusion@#The study found that age, sex, occupation, residence, sputum smear results, drug resistance, and history of previous treatment were associated with unsuccessful treatment outcome.
Subject(s)
Philippines , Tuberculosis, Pulmonary , Treatment Outcome , Regression AnalysisABSTRACT
OBJECTIVE@#The primordial principle in living kidney donation is leaving the better functioning kidney (BFK) with the donor. However, when laparoscopic donor nephrectomy (LDN) is utilized, certain conditions may warrant removing the BFK. These include lesser complex vasculature, renal calculi, or left-sidedness. Reported here are the long-term outcomes of removing the BFK among living donors.@*METHODS@#Chart review was done on all donor nephrectomy patients over a five-year period. Patients whose BFK were removed via LDN were identified. Clinical indications, patient demographics, perioperative and postoperative outcomes were summarized. Creatinine and eGFR at one-day, one-month and one-year follow-up were used to determine renal functional outcomes.@*RESULTS@#Between January 2011 to December 2015, 810 donor nephrectomies were performed: 366 (45.2%) and 444 (54.8%) had open donor nephrectomy and LDN, respectively. BFK was removed in 26 (5.8%) in the LDN and none in the open group. Mean age was 28.9+7.5 (18-49), with a male to female ratio of 4:1. The clinical indications were less complex vasculature in 18 (69%), left-sided BFK in 7 (27%) and renal calculi in 1 (3.8%). The mean operative time was 173 +25 (130–272) minutes, with a mean blood loss of 111 +96 (50-200)cc. The mean length of stay was 3.0+0.2 (2.8-4) days. Grade 1 complications were seen in 5 (19%) patients. There was no mortality. The eGFR after 1 year is 79.4+14.1 (54-91) cc/min.@*CONCLUSION@#Removing the BFK during LDN does not impact negatively on the safety and renal functional outcomes of living kidney donors.
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INTRODUCTION AND OBJECTIVES@#Laparoscopic adrenalectomy is the standard treatment for adrenal tumors.Described here is the authors’ 10-year experience with laparoscopic adrenalectomy in a single center.@*METHODS@#A retrospective chart review was done on all patients who underwent laparoscopicadrenalectomy from January 2006 to January 2016 at the National Kidney and Transplant Institute.The authors determined the patient demographics (age and gender), tumor characteristics (size,functionality and laterality) and surgical outcomes (operative time, estimated blood loss, conversionto open and complications according to the Clavien-Dindo classification).@*RESULTS@#A total of 90 patients underwent laparoscopic adrenalectomy. The female to male ratio was1.4:1. Most tumors were left-sided [48/90 (53%)], with a mean size of 3.0 ± 0.75cm. The operativetime was 145 ± 35 minutes. The mean estimated blood loss was 50 ± 100cc. The length of hospitalstay was 3.0 ± 1 days. Forty six percent (42/90) of the adrenals were functioning: Hyperaldosteronism(26), Pheochromocytoma (14), and Cushing's syndrome (2). Ninety eight percent(88/90) were benign. There were 2 (2.2%) conversions to open. There were 8 complications (8.89%)(all Dindo-Clavien Class II), all of which were managed conservatively. There was no mortality.@*CONCLUSION@#The authors’ experience with laparoscopic adrenalectomy shows that it is safe and effectivefor adrenal tumors.
Subject(s)
LaparoscopyABSTRACT
The mortality rate for people living with sickle cell disease is high and relatively a few patients among them reach adult life, even with a high standard of medical care. Clinical manifestations of the sickle cell disease are diverse and vary, falling into three major categories: anaemia, pain related issues and organ failure. Sickle cell crises or painful episodes may be caused by blood vessel occlusion, damaged organ, triggered by membrane deformation. Patients in West Africa, where sickle cell anaemia (SCA) is prevalent, have for ages been treated with natural products especially herbs as it is still the case in rural communities. The medicinal plant Clerodendrum polycephalum used for this study is used ethno medically in treating malaria and pains associated with sickle cell disease. The leaves were collected, oven dried and macerated in methanol for 72 h. The extract was dried and reconstituted in distilled water to give concentrations 0.25 mg/mL, 0.5 mg/mL, 1 mg/mL, 2 mg/mL and 4 mg/mL. The methanol extract was further fractionated into solvents of varying polarity viz: n-hexane, dichloromethane, ethyl acetate and water. All extracts and fractions were tested for their antisickling properties using the inhibitory and reversal models. Vanillic acid and p-hydroxybenzoic acid were used as the positive controls for the inhibitory and reversal assays respectively. An attempt was made to identify the different classes of compounds present in the extract by using thin layer chromatography technique. The methanol extract of C. polycephalum gave 55.9% inhibitory and 65.63% reversal activities at 4 mg/mL. The antisickling activities were dose-dependent and purification significantly (p<0.05) enhanced the reversal activity which was indicated in the polar fractions. This study authenticated the use of C. polycephalum in the management of pains associated with sickle cell disorder.
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BACKGROUND: Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU). METHODS: This retrospective observational study included patients undergoing general anesthesia over a 12-month period. Using multiple variable penalized logistic regression in a one-group before-and-after design, we compared the categorized rates of PACU MV to examine the effect of sugammadex introduction following a post-hoc chart review to ascertain the reason for postoperative MV. Additionally, multiple variable linear regression was used to assess for differences in PACU LOS and emergence time within a propensity-matched set of patients receiving neostigmine or sugammadex. RESULTS: In total, 7,217 surgical cases met the inclusion criteria: 3,798 before and 3,419 after sugammadex introduction. The incidence of PACU MV was 2.3% before and 1.8% after (P = 0.118) sugammadex introduction. PACU MV due to residual neuromuscular blockade (rNMB) decreased from 0.63% to 0.20% (P = 0.005). Ventilation because of other causes was unchanged. PACU LOS and emergence time were unchanged in the propensity-matched set of 1,444 patients. CONCLUSIONS: rNMB was an important contributor to PACU MV utilization and its incidence significantly decreased after sugammadex introduction. The selected efficiency measures may not have been sufficiently granular to identify improvements following introduction.
Subject(s)
Humans , Academic Medical Centers , Anesthesia , Anesthesia, General , Delayed Emergence from Anesthesia , Incidence , Length of Stay , Linear Models , Logistic Models , Neostigmine , Neuromuscular Blockade , Observational Study , Respiration, Artificial , Retrospective Studies , VentilationABSTRACT
Background: This study addresses the prevalence and clinical presentation of patients with primary open angle glaucoma (POAG) in the greater Accra metropolitan area. Methods: This is a retrospective case series of 455 patients (813 eyes) at the Emmanuel Eye Clinic. Patients were diagnosed from May 2008 to Nov 2011. The definition of POAG conformed to the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Information collected included basic demographic data; distribution of glaucoma subtypes; measured intraocular pressure (IOP); best corrected visual acuity (BCVA) and optic disc measurements. Results: Nearly 24 presented blind in at least one eye. The average age was 56.7 +/-16.7 years and the average IOP was 33.9 mmHg +/- 12.7 mmHg for right eyes and 33.5 mmHg +/-12.0 mmHg for left eyes. The mean vertical cup to disc ratio (vCDR) was 0.83 for right eyes versus 0.82 for left eyes. A total of 32 patients (53 eyes) were diagnosed with normal tension glaucoma (NTG). Statistically significant differences between the NTG and high tension groups included age (45.3 +/- 16.7 vs. 56.7 +/-16.7; p0.001); mean IOP (19.1 mmHg +/- 4.5 mmHg vs. 33.7 +/- 12.4 mmHg; p0.001) and mean vCDR (0.76 +/- 0.17 vs. 0.83 +/- 0.10; p0.01). Comparing age-matched NTG patients with high tension glaucoma patients showed no significant difference in vCDR. Conclusions: The clinical presentation of POAG at the Emmanuel Eye Center is characterized by elevated IOP and grossly advanced optic neuropathy. Significant differences between high tension glaucoma and NTG were identified
Subject(s)
Glaucoma , Intraocular Pressure , Low Tension Glaucoma , Retrospective StudiesABSTRACT
BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs), sarcomas originating from tissues of mesenchymal origin, are rare in patients without a history of neurofibromatosis. CASE REPORT: We report a case of an MPNST of the spinal accessory nerve, unassociated with neurofibromatosis, which metastasized to the brain. The tumor, originating in the intrasternomastoid segment of the spinal accessory nerve, was removed. Two years later, the patient presented with focal neurological deficits. Radiographic findings revealed a well-defined 2.2x2.2x2.2 cm, homogeneously enhancing mass in the left parieto-occipital region of the brain surrounded by significant vasogenic edema and mass effect, culminating in a 1-cm midline shift to the right. The mass was surgically removed. The patient had nearly complete recovery of vision, speech, and memory. CONCLUSIONS: To our knowledge, this is the first documented case of an MPNST arising from an extracranial segment of the spinal accessory nerve and metastasizing to the brain.
Subject(s)
Humans , Accessory Nerve , Brain , Edema , Nerve Sheath Neoplasms , Neurofibromatoses , Sarcoma , Vision, OcularABSTRACT
<p><b>INTRODUCTION</b>Highly active antiretroviral therapy (HAART) has improved outcomes for individuals infected with human immunodeficiency virus (HIV). This study describes the causes of death in hospitalised HIV-positive patients from 2008 to 2010 in Tan Tock Seng Hospital, the national referral centre for HIV management in Singapore.</p><p><b>MATERIALS AND METHODS</b>Data were retrospectively collected from HIV-positive patients who died in Tan Tock Seng Hospital from January 2008 to December 2010.</p><p><b>RESULTS</b>Sixty-seven deaths occurred in the study period. A majority of patients died of non-acquired immune deficiency syndrome (AIDS)-defining illnesses (54.7%). The median CD4 count was 39.5 (range, 20.0 to 97.0), and 7 patients had HIV viral loads of <200 copies/mL. There were 27 deaths due to opportunistic infections, 27 due to non AIDS-defining infections, 4 due to non AIDS-associated malignancies. This study also describes 3 deaths due to cardiovascular events, and 1 due to hepatic failure. Patients who had virologic suppression were more likely to die from non AIDS-defining causes.</p><p><b>CONCLUSION</b>Causes of death in HIV-positive patients have changed in the HAART era. More research is required to further understand and address barriers to testing and treatment to further improve outcomes in HIV/AIDS.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Anti-Retroviral Agents , Therapeutic Uses , CD4 Lymphocyte Count , Cause of Death , HIV Seropositivity , Drug Therapy , Epidemiology , Mortality , Hospital Mortality , Hospitalization , Medical Audit , Retrospective Studies , Singapore , EpidemiologyABSTRACT
Background: It is believed that intensive care greatly improves the prognosis for critically ill children and that critically ill children admitted to a dedicated Paediatric Intensive Care Unit (PICU) do better than those admitted to a general intensive care unit (ICU). Methods: A retrospective study of all paediatric (< 16 years) admissions to our general ICU from January 1994 to December 2007. Results: Out of a total of 1364 admissions, 302 (22.1%) were in the paediatric age group. Their age ranged from a few hours old to 15 years with a mean of 4.9 ± 2.5 years. The male: female ratio was 1.5:1. Postoperative admissions made up 51.7% of the admissions while trauma and burn made up 31.6% of admissions. Medical cases on the other hand constituted 11.6% of admissions. Of the 302 children admitted to the ICU, 193 were transferred from the ICU to other wards or in some cases other hospitals while 109 patients died giving a mortality rate of 36.1%. Mortality was significantly high in post-surgical paediatric patients and in patients with burn and tetanus. The length of stay (LOS) in the ICU ranged from less than one day to 56 days with a mean of 5.5 days. Conclusion: We found an increasing rate of paediatric admissions to our general ICU over the years. We also found a high mortality rate among paediatric patients admitted to our ICU. The poor outcome in paediatric patients managed in our ICU appears to be a reflection of the inadequacy of facilities. Better equipping our ICUs and improved man-power development would improve the outcome for our critically ill children. Hospitals in our region should also begin to look into the feasibility of establishing PICUs in order to further improve the standard of critical care for our children
Subject(s)
Child , Intensive Care Units , Patient Admission , Pediatrics , Retrospective Studies , Treatment OutcomeABSTRACT
Dengue virus (DENV) is a leading cause of morbidity and mortality in most tropical and subtropical areas of the world. Dengue virus infection induces specific CD4+CD8– and CD8+CD4– T cells in humans. In primary infection, T-cell responses to DENV are serotype cross-reactive, but the highest response is to the serotype that caused the infection. The epitopes recognized by DENV-specific T cells are located in most of the structural and non-structural proteins, but NS3 is the protein that is most dominantly recognized. In patients with dengue hemorrhagic fever (DHF) caused by secondary DENV infection, T cells are highly activated in vivo. These highly activated T cells are DENV-specific and oligoclonal. Multiple kinds of lymphokines are produced by the activated T cells, and it has been hypothesized that these lymphokines are responsible for induction of plasma leakage, one of the most characteristic features of DHF. Thus, T-cells play important roles in the pathogenesis of DHF and in the recovery from DENV infection.
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Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested; interviewer administered; structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently; participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9and 12.0of participants in the intervention and control groups; respectively; had heard of Pap smears. Furthermore; less than 10had correct information on the use of the Pap test. Post-intervention; there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (p
Subject(s)
Awareness , Mass Screening , Uterine Cervical Neoplasms , Vaginal SmearsABSTRACT
<p><b>INTRODUCTION</b>Food-dependent exercise-induced anaphylaxis (FDEIA) is an uncommon and under-recognised syndrome that clinicians may not consider in a patient presenting with anaphylaxis.</p><p><b>CLINICAL PICTURE</b>We describe here 5 patients aged 9 to 20 years old who presented at a local tertiary hospital over a 2-year period from August 2006 to July 2008. All presented with urticaria, 4 were hypotensive, 2 had angioedema and another 2 had dyspnoea. The symptoms occurred between 15 and 150 minutes (mean, 81) after exercising and consuming various food. All had consumed shellfish. All patients were admitted with the diagnosis of anaphylaxis of undefined aetiology. Diagnosis of FDEIA was only reached upon referral to an allergist.</p><p><b>TREATMENT AND OUTCOME</b>Patients were treated with standard medicines for anaphylaxis including adrenaline, antihistamines, steroids and fluid flushes. Symptoms resolved in 2 to 3 days with no further episodes. At discharge, patients were prescribed epinephrine auto-injectors and given written anaphylaxis management plans.</p><p><b>CONCLUSIONS</b>More public awareness and strategies to ensure accurate diagnosis and management of this condition are necessary.</p>
Subject(s)
Adolescent , Animals , Child , Female , Humans , Male , Young Adult , Anaphylaxis , Drug Therapy , Angioedema , Bronchodilator Agents , Therapeutic Uses , Dyspnea , Epinephrine , Therapeutic Uses , Exercise , Food Hypersensitivity , Diagnosis , Drug Therapy , Retrospective Studies , Seafood , Toxicity , Syndrome , Urticaria , Vasoconstrictor Agents , Therapeutic UsesABSTRACT
OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.
Subject(s)
Humans , Colorectal Neoplasms , Neoadjuvant Therapy , Colorectal Surgery , Rectal Neoplasms , Chemoradiotherapy , Colonic Neoplasms , Polyps , Patient Care TeamABSTRACT
Background: The aim of this study was to describe the outcome and determine the prognostic factors of outcome of childhood rhabdomyosarcoma in a tertiary hospital in a developing country. Patients and Methods: This was a retrospective review of the clinical presentation; investigation; intervention; and treatment outcomes of children with rhabdomyosarcoma in our hospital over a 7-year period. Statistical analysis was performed using Chi-square test. Results: A total of 18 patients were identified with two-thirds being males (n = 12) with median age of 7 years. Most of the children were below 10 years of age. Lower limbs tumour predominated (n = 6) followed by the upper limbs and head and neck (n = 4 each). Other sites included perianal/perineal (n = 3) and the orbit (n = 1). Two patients were Intergroup Rabdomyosarcoma Study (IRS) group I; four group II; five group III; and seven group IV. Lymph node involvement was the commonest site of metastasis. Clinical group and stage was significantly more advanced in patients older than 10 years compared to younger than 10 years (P = 0.010; P = 0.008; respectively). There were 12 patients with alveolar disease while six had embryonal type of rhabdomyosarcoma. Treatment was by combination chemotherapy; and surgical excision which was done primarily in 11; after chemotherapy in four; and after radiotherapy in one. Two had biopsy only. Five patients are alive; two of them without evidence of disease at average follow-up period of 2 years. Conclusion: Mortality from rhadomyosarcoma in our setting is still unacceptably high. Late presentation may be the major contributor to high mortality. A more aggressive multimodality treatment approach may improve the outcome