Naga Municipal Hospital

Background:The evolution of nasopharyngeal carcinoma (NPC) involves potential transitions among states of recurrence, metastasis, and/or remission. Understanding the dynamics of NPC progression following radical radiotherapy may help optimize surveillance protocols and patient management.Objectives:To characterize the progression dynamics of NPC following radical radiotherapy.Design:A retrospective study.Methods:The cohort comprised NPC patients who underwent radical intensity-modulated radiotherapy between 2016 and 2022. A multi-state Markov model was employed to estimate transition intensities and probabilities across various disease states, including failure-free, single failure event (recurrence or metastasis, R/M), multi-event progression (recurrence and metastasis, R&M), and death. A Shiny-based web tool was developed to facilitate the clinical translation of the model.Results:A total of 4800 NPC patients were included, yielding 18,641 disease-state assessments, with a median follow-up of 3.3 years. The transition intensity from metastasis to death (0.025, 95% confidence interval (CI), 0.021–0.029) was 2.3 times greater than that from recurrence to death (0.011, 95% CI, 0.009–0.014). The estimated probabilities of remaining failure-free, experiencing R/M, and deteriorating to death were 89.9%, 7.7%, and 2.1% at 2 years, respectively. Among patients with recurrence, the probabilities of progression to metastasis and death were 3.8% and 24.5%; among those with metastasis, the probabilities of progression to recurrence and death were 2.1% and 45.0%, respectively. Increasing age, male sex, advanced TNM stage, higher pre-treatment Epstein-Barr virus (EBV) DNA, and detectable post-treatment EBV DNA were associated with treatment failure. A web tool was developed to predict NPC disease-state transitions at 2 years.Conclusion:These findings provide initial evidence on the dynamic progression of NPC, which may inform clinical management and patient counseling. Risk-stratified screening and targeted interventions could help mitigate disease progression.

The high prevalence of adolescent pregnancy in Timor-Leste reflects vulnerabilities in adolescents’ reproductive health, particularly limited knowledge and unfavorable attitudes toward sexuality, which increase engagement in premarital sexual behavior and the risk of unintended pregnancy. However, empirical evidence explaining the role of reproductive health status in linking these outcomes, as well as the effectiveness of video-based reproductive health education in low-resource settings, remains limited. This study aimed to evaluate the effectiveness of video-based reproductive health education in improving knowledge and attitudes toward teenage pregnancy among female adolescents. A quasi-experimental one-group pretest–posttest design was conducted among 96 female students aged 17–18 years at ESGP de Suai, Covalima, Timor-Leste, selected through simple random sampling. The intervention consisted of a 15 minute reproductive health education video addressing adolescent pregnancy, related risks, and prevention strategies. Knowledge (20 items) and attitudes (10 items) were measured using a validated questionnaire (Cronbach’s α = 0.679 and 0.520, respectively). Effectiveness was defined as a statistically significant improvement in post-intervention knowledge and attitude scores. Data were analyzed using the Wilcoxon signed-rank test and the Mann–Whitney U test. Significant improvements were observed in knowledge (Z = −8.526; p < 0.001) and attitudes (Z = −8.532; p < 0.001) after the intervention. No significant difference was found between the magnitude of improvement in knowledge and attitudes (p = 0.850). Video based reproductive health education effectively improves adolescents’ knowledge and attitudes toward teenage pregnancy and represents a feasible intervention for adolescent reproductive health promotion in resource-limited settings.

The relationship of body mass index (BMI) with clinical outcomes in patients with acute myocardial infarction (AMI) remains incompletely understood. In this study, 1113 patients with AMI who underwent percutaneous coronary intervention (PCI) were identified in the Rural AMI registry. Patients were divided into three groups based on BMI: underweight < 18.5 kg/ m², normoweight ≥ 18.5 to < 25.0 kg/ m², and overweight ≥ 25.0 kg/ m². The following data are given in this order. The endpoint of the study was in-hospital mortality. Underweight patients were older (77 ± 10 versus 69 ± 12 versus 63 ± 13 years; P < 0.001) and more likely to be female (38.5 versus 22.9 versus 20.2%; P = 0.009), and had a higher incidence of Killip class ≥ III (24.6 versus 12.7 versus 11.4%; P = 0.03). The median B-type natriuretic peptide levels on admission were 165 (interquartile range [IQR]: 73 - 565), 93 (IQR: 30 - 281), and 63 (IQR: 24 - 189) pg/mL (P < 0.001). The door-to-balloon time and postprocedural Thrombosis In Myocardial Infarction flow grades were similar among the BMI groups. During hospitalization, there were 65 all-cause deaths, with in-hospital mortality of 18.5%, 5.2%, and 4.7% in underweight, normoweight, and overweight patients, respectively (P = 0.001). In logistic regression analysis, the underweight group was significantly associated with in-hospital mortality using inverse probability of treatment weighting (odds ratio, 2.61; 95% confidence interval: 1.18 - 5.79, P = 0.02). These results suggest that assessment of BMI provides useful information for predicting in-hospital mortality in patients with AMI undergoing PCI.

Abdominoperineal resection with permanent colostomy has historically been performed for very low rectal cancer located near the anal canal. Anus-preserving surgeries, such as intersphincteric resection (ISR) and low anterior resection (LAR), have recently become more common. However, postoperative anal function is a concern in these surgeries when the anastomosis is very low. The aim of this study was to examine changes in anal function and factors that worsen anal function after surgery for rectal cancer. A multicentre (47 facilities), non-randomized, single-arm phase II trial was conducted prospectively using the Wexner score questionnaire between 2014 and 2017. A total of 278 patients who underwent laparoscopic surgery for clinical Stage I very low rectal cancer were analysed using a mixed-effects model. Anal function temporarily worsened 3 months after surgery, but gradually recovered and spontaneously returned to an acceptable level in 3 years. In a comparison of surgical procedures, anal function was significantly better after LAR than after any type of ISR. There was little difference in anal function after total ISR, subtotal ISR and partial ISR. In the mixed-effects model analysis, ISR and older age (≥75 years) were identified as independent factors that worsened postoperative anal function. The results showed early deterioration of anal function followed by gradual improvement to an acceptable level after surgery. There is a higher risk of poor postoperative anal function after ISR and in older patients, and these risk factors should be communicated to patients when obtaining consent for the surgery.

We report a rare case of the independent coexistence of lung cancer and organizing pneumonia (OP) in different lobes of the right lung in a 67-year-old man with a history of left upper lobectomy. Computed tomography revealed a lesion consistent with OP in the right upper lobe and a suspicious shadow in the right lower lobe, which was diagnosed as squamous cell carcinoma via bronchoscopic biopsy. The patient underwent right lower lobectomy and partial resection of the right upper lobe under left one-lung ventilation. Empirical corticosteroids were administered preoperatively, followed by a brief postoperative course for 3 days after pathological confirmation of OP to reduce complications such as bronchial fistula, then transitioned to macrolide therapy for 3 months. Fourteen months postoperatively, OP had not recurred, although bone metastases developed and responded well to chemoradiotherapy. This case highlights the need for individualized perioperative management in patients with complex pulmonary pathology.

Mycobacteriummalmoenseis a rare species ofnon-tuberculosis mycobacteriadetected in Japan that causes pulmonary infection and cervical lymphadenitis. Here, we report a case of pulmonary infection caused byM. malmoense, which was difficult to distinguish fromMycobacterium tuberculosis(Mtb) infection. A 64-year-old Japanese woman with a history of pulmonarytuberculosishad bloody phlegm, a cough, and discomfort in her chest. Chest computed tomography revealed a cavity, infiltration, and a nodule. A smear test for acid-fast bacilli was positive, aMycobacteriumaviumcomplex transcription reverse-transcription concerted (TRC) test was negative, and an Mtb TRC test was withheld because the internal control was negative. After diluting the specimens, the internal control tested positive, and the sample tested negative. We diagnosed pulmonaryM. malmoenseinfection based on a culture test. In conclusion, attention should be paid to the concentration of bacteria in Mtb TRC test samples, ensuring that the internal control provides expected results.

Aim: We compared the effectiveness of rush subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) using standardized house dust mite (HDM) extract for pediatric bronchial asthma (BA). Methods: We followed the pediatric BA treatment score during 3 years of treatment. We assessed the median time to no longer requiring long-term control pharmacotherapy (LTCP) for BA (LTCP-free). We compared the outcomes after adjustment for confounding factors and propensity score matching. Results: Patients in the HDM SCIT group achieved the LTCP-free status significantly earlier than those in the HDM SLIT group after adjustment for confounding factors and propensity score matching. Conclusion: Patients treated for pediatric BA with rush HDM SCIT had earlier onset of therapeutic effects than those with HDM SLIT.