Mount Alvernia Hospital

IntroductionSatisfactory management of acute pain remains a major medical challenge despite the availability of multiple therapeutic options including the fixed-dose combination (FDC) drugs. Tramadol and dexketoprofen trometamol (TRAM/DKP) 75/25 mg FDC was launched in 2018 in Asia and is widely used in the management of moderate to severe acute pain. There are limited data on its effectiveness and safety in Asian patients, and therefore, a need to better understand its usage patterns in clinical practice. We aim to understand the usage pattern of TRAM/DKP FDC, its effectiveness and tolerability in patients with moderate to severe acute pain in Asia.Methods and analysisREKOVER is a phase-IV, multicountry, multicentre, prospective, real-world observational study. A total of 750 postsurgical and non-surgical patients (male and female, aged 18–80 years) will be recruited from 13 tertiary-care hospitals (15 sites) in Singapore, Thailand, the Philippines and Malaysia. All patients prescribed with TRAM/DKP FDC and willing to participate in the study will be enrolled. The recruitment duration for each site will be 6 months. The severity of pain will be collected using Numeric Pain Rating Scale through the treatment period from day 1 to day 5, while satisfaction with the treatment will be evaluated using Patient Global Evaluation Scale at the end of treatment. Any adverse event reported during the study duration will be recorded for safety analysis (up to day 6). The study data will be entered into the ClaimIt portal and mobile application (app) (ObvioHealth, USA). All the inpatient data will be entered into the portal by the study site and for outpatient it will be done by patients through an app.Ethics and disseminationThe study has been approved by the local ethics committee from each study sites in Singapore, Thailand, the Philippines and Malaysia. Findings will be disseminated through local and global conference presentations, publications in peer-reviewed scientific journals and continuing medical education.

Background and objectiveLow adiponectin levels have been described in conditions with high cardiometabolic risk, including obesity, type 2 diabetes, insulin resistance, and hyperlipidaemia. Psoriasis is a chronic inflammatory skin disorder, and it is also associated with these conditions. In this study, we sought to assess the correlation between adiponectin levels and these risk factors including psoriasis severity. We investigated adiponectin value and its correlation with components of metabolic syndrome (MetS) and psoriasis severity.MethodsSerum adiponectin levels were obtained from 215 psoriasis patients in a tertiary dermatology centre in Singapore. Psoriasis severity was measured with the psoriasis area and severity index (PASI), and cardiometabolic risk factors including obesity, hyperlipidaemia, insulin resistance, and waist circumference were measured. Patients answered a questionnaire regarding alcohol use, exercise, family history, smoking, and treatment history.ResultsLow adiponectin value was found in psoriasis patients with high body mass index (BMI) risk, high low-density lipoprotein (LDL), and low high-density lipoprotein (HDL). Patients with low HDL value had 25% lower adiponectin value compared to those with normal HDL. Adiponectin levels had a negative correlation with waist circumference. Psoriasis patients with MetS and a family history of cerebral vascular accidents (CVAs) had 17% and 18% lower adiponectin values than those without, respectively. There was no correlation between adiponectin level and PASI score.ConclusionAdiponectin levels were significantly decreased in psoriasis patients with obese-level BMI, MetS, increased abdominal girth, low HDL, high LDL, and a family history of CVA. Low adiponectin levels could play a role in predicting the development of MetS and possibly enable intervention to decrease the risk of cardiovascular mortality in psoriatic patients.

annual age-adjusted breast cancer death rates for women in the United States remained remarkably constant, oscillating around 32 deaths per 100,000 over 60 years. During this long timeframe, the surgical treatment of breast cancer evolved from radical mastectomy with mandatory lymph node dissection to lumpectomy coupled with radiation therapy. With this new paradigm, lymph node dissection was reserved for women with tumor-invaded axillary lymph nodes. Beginning in the 1970s, chemotherapy after surgery (adjuvant) and before surgery (neoadjuvant) was added to surgical treatment. The radical diminution in the scope of breast surgery did not alter the national breast cancer death rate. Doing less surgery was neither harmful nor beneficial to long-term survival from breast cancer. In the 1980s two events changed this static picture: the addition of tamoxifen to adjuvant and neoadjuvant chemotherapy, and the introduction of mammography. Beginning in 1990 annual breast cancer death rates in the United States began to fall, and have continued to fall each year since then. In 2001, the last year of published statistics, the breast cancer death rate was 26 deaths per 100,000. Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography. Abnormal mammograms demand a breast biopsy since only one in five abnormal mammograms is actually a breast cancer. Consequently, widespread adoption of mammography has produced an image-guided breast biopsy industry in the United States. Open, surgical breast biopsy has been replaced with image-guided breast biopsy because improved breast biopsy tools have made image-guided breast biopsy equivalent in accuracy to open, surgical breast biopsy. These tools, in turn, have changed the professional lives of surgeons, pathologists, and mammographers, leading to the development of dedicated breast surgeons, breast pathologists, and interventional breast radiologists.