Are our patients different? A 5-year review of cervical cancer cases managed in tertiary Gynaecological Cancer Unit in Malaysia

Objective: The purpose of this review is examine the clinicopathological characteristics of cervical cancer treated in this situation from 2010 to 2014. Method: This is an observational retrospective study. All cases of cervical cancer treated in this institution from January 2010 until December 2014 were reviewed. Clinicopathological characteristics were recorded and analysed using SPSS version 20. Result:There were 31 cases of cervical carcinoma identified during that 5-year period. The mean age at diagnosis was 51.0 0±12.7 years(range,29-78 years).The majority of them (87%) were diagnosed before the age 70. None of the patients participated in cervical cancer screening programme and as a result less than 10% of women were diagnosed following an abnormal pap smear test. More than 90& were symptomatic, out of 82% were abnormal per vaginal bleeding and the remaining 11% and 7% were postcoital bleeding and compressive symptoms respectively. Risk factors for cervical cancer were identified in less than a third of the patients. Premorbid medical conditions were identified in only 50% of patinets and 94% were hypertension and/or diabetes mellitus. Similarly, the majority (94%) were categorised as having either ECOG functional class 0 and 1 i.e. 81 % and 13% respectively. There was an equal breakdown between squamous cell carcinoma(SCC) and adenocarcinoma(ACC), which was 48.4% each and the remaining 3.2% were others. For SCC,nearly all(94%)were large cell non-keratinising SCC with only 6% were large cell keratinising SCC subtype. As for ACC, the majority type were mucious endocervical subtype (47%), 40% were classified and the remainig 13% were others. Almost all (96.8%) patients had an examination under anaesthesia (EUA) and diagnostic imaging in the form of computer axial tomography(CT) scan to rule out the locoregional and distance metasis. Just above the half(55%) of the patient presented with stage 1b i.e. 29% 1b1 and another 26% 1b2. Stage 2 contributed to about 23% and which 13% were 2a and 10% were 2b. Stage 3 and stage 4 disease accounted for the remaining 9% and 13% respectively. About two-third of patients went on to have treatment with us and the remaining one- third sought an alternative form of treatment. Out of this, 47% had Wertheim’s hysterectomy,6% had neoadjuvant chemotherapy, followed by Wertheim’s hysterectomy, 20% had concurrent chemoradiation and the remaining 13% had palliative treatment. From the 16 patients who had Wertheim’s hysterectomy, 8 of them (50%) required further adjuvant treatment in the form of radiotherapy. Conclusion: The incidence of adinocarcinoma is higher than other study. Only one third of our patients had early disease at presentation, which is likely to poor cervical smear uptake. Our adjuvant radiotherapy rate was higher compared to others as most of our patients preferred surgery (even they needed adjuvant radiotherapy) compared to concurrent radiotherapy alone

The “crazy paving pattern” lung in a pregnant woman

Pulmonary Alveolar Proteinosis (PAP) is a rare disorder characterized by an abnormal accumulation of a PAS positive material within the alveolar spaces and distal bronchioles. A 29 year old lady in her 29th week of pregnancy presented with prolonged dry cough for two months which was associated with reduced effort tolerance and low grade fever. At presentation she is hypoxic and required oxygen supplement. She was initially treated empirically for tuberculosis but she continued to have worsening hypoxia. A high resolution CT thorax revealed a crazy paving pattern lung which was suggestive of PAP. She delivered a healthy baby at 36 weeks via an elective Caesarean section. Post operatively she underwent diagnostic bronchoalveolar lavage which showed acellular homogenous eosinophilic material which was positive for PAS/PASD and negative for mucin. Therapeutic whole lung lavage was performed and her symptoms and lung function tests improved. In this case report, we will discuss how we made the diagnosis of PAP and share our experience in managing a pregnant woman with this condition

An undiagnosed non functioning retroperitoneum paraganglioma, complicating a gynaecological surgery; a case report

Paragangliomas are uncommon tumors arising from the neuroendocrine elements (chief cells) of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical findings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is diffi cult and only few cases have been made before exploratory laparotomy. Although our patient was initially planned and operated by our gynaecological team, the incidental fi ndings had to involve the general surgeons. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence

Integrating a Mobile-Learning Platform for Enhancing Clinical Teaching: The Learners’ Perspective

The role of mobile technology has become an integral part of daily activity among today’s society, including medical schools and hospitals. This study aimed to establish a mobile-learning platform for providing high-quality clinical teaching in undergraduate medical education. It was a mixed-methods design of quantitative survey and qualitative focus-group discussions to analyse the learners' view for acceptance of technology-integrated learning in clinical teaching at Universiti Sultan Zainal Abidin. Forty-two undergraduate medical students from years 3 and 5 participated in this study. The vast majority found that a mobile-learning platform was a helpful medium for the integration of leaning resources and collaboration with other health-care professionals in a clinical setting (p<0.001). They generally agreed that there is an improvement in clinical competence, confidence in clinical reasoning and focusing on the discussion by providing constructive feedback (p<0.001). The qualitative focused group discussion’s findings indicated that most of the participants expressed their satisfaction with improving their intellectual skills and their anticipation of achieving strategic learning via integrated bedside teaching with mobile-group discussions. Overall, the participants accepted that a mobile-learning platform integrated bedside teaching is a constructive, productive approach for enhancing and facilitating their learning in a clinical setting. This study offered a unique insight into learners’ perceptions of benefits and the limitation of technology-enhanced learning in undergraduate medical training. The essential attributes of mobile technology are crucial for technology integration in high-quality clinical teaching