Western Regional Hospital

To present our experience in the management of penile cancer (PC) in the context of a country with limited resources. This was a cross-sectional study with retrospective data collection and descriptive aim. It was conducted over a 20-year period from 1 January 2005 to 31 December 2024. The frequency was 1.05 cases per year. The mean age of the patients was 60.23±13.10 years. A proportion of 76.19% (n=16) of patients were uncircumcised. One patient was HIV positive. Ulceration of the penis was the main reason for consultation (88.23%). The average time to consultation was 11.7±11.37 months. Phimosis was observed in 2 patients. The histological type found was squamous cell carcinoma in all cases. Stage cT3 was the most common (71.42%), followed by stage cT4 in 28.58%. Twelve patients underwent surgical treatment. Total penectomy was performed in 5 patients, partial penectomy in 6 patients and emasculation in one patient. Node dissection was performed in 3 patients. The one-year survival rate was 83.33%. Penile cancer is rare and consultations are made at advanced stages. Awareness of the population on risk factors remains essential for early diagnosis and prevention.

Abstract The May Measurement Month (MMM) campaign was conducted in Australia in 2023 to raise awareness of raised blood pressure (BP). This article reports the results of the campaign. Adults aged ≥18 years were recruited through convenience sampling in metropolitan and regional Australia including hospitals, universities, pharmacies, libraries, and community centres. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90 mmHg. Multiple imputation was used to estimate missing BP readings. In total, 2284 were screened, with a mean age of 39.5 years and 52.1% of whom were female. Of all participants, 679 (29.7%) had hypertension, of whom 356 (52.4%) were aware, and 315 (46.4%) were on antihypertensive medication. Of those on antihypertensive medication, 156 (49.5%) had controlled BP, and of all participants with hypertension, 23.0% had controlled BP. The MMM campaign in Australia identified a substantial number of participants with untreated or inadequately treated hypertension. The MMM campaign continues to be a cost-effective strategy in Australia to screen participants for hypertension, assess BP control and refer participants to primary care physicians where appropriate. Further efforts from all stakeholders are essential to further improve the reach of the MMM campaign in Australia, to increase awareness and improve BP control in line with the National Hypertension Taskforce of Australia Roadmap.

Background: Malignant mucosal melanoma of the nasal cavity is a rare tumor with agressive characteristic and poor prognosis. Modern radiotherapy modalities such as Intensity-Modulated Radiotherapy (IMRT), VMAT, and brachytherapy offer the potential of the improvement of local control in tumor that historically known as radioresistant. The aim of this case report is to discuss malignant melanoma of the nasal cavity and the impact of radiotherapy, with a focus on re-irradiation using VMAT and brachytherapy in this diasase. Case description and Discussion: A man, 61 years old was diagnosed with malignant melanoma of the nasal cavity based on imaging and histopathology result. The patient underwent four cycles of chemotherapy, followed by external beam radiotherapy using IMRT technique with total dose 70 Gy/35 fractions. Post-treatment evaluation revealed residual mass, leading to re-irradiation using VMAT at 50 Gy/25 fractions, followed by Ir-192 brachytherapy at 16 Gy/4 fractions using a nasopharyngeal applicator. The cumulative total BED administered exceeded >160 Gy. Side effects on organs at risk were minimal, and post-treatment nasal bleeding and nasal congestion symptoms did not recur. Conclusion: A Multimodal approach combining IMRT, re-irradiation of VMAT, and brachytherapy demonstrates promising clinical outcomes in cases of malignant melanoma of the nasal cavity. The administration of a high cumulative Biological Effective Dose (BED) enables optimal tumor control without increasing toxicity to surrounding organs. This strategy is worth considering in the management of inoperable or locally recurrent head and neck mucosal melanoma.

This study aims to determine the extent to which water, sanitation and hygiene (WASH) coverage is established in rural schools, and the barriers to accessing WASH services in the Dehiovita educational zone of the Kegalle District in Sri Lanka. Random sampling was used to collect data from 500 students in grades 7–13 from 15 schools using a semi-structured questionnaire. The analysis shows that 43% of children use unsafe plastic bottles, 62% reported broken taps as a major barrier to safe access to water, and 54% reported receiving inadequately treated water. The majority of respondents (88%) mentioned that they do not use soap after using the toilet. In terms of menstrual hygiene management, 26% of female students do not use the sanitation facilities due to issues such as poor quality or safety concerns in the sanitary services provided, and this may prevent the achievement of gender justice in WASH coverage. These findings highlight the urgent need to raise awareness in schools about safe water consumption, sanitation, hygiene practices and spread of water-borne diseases.

Breast cancer is the leading cause of cancer among women and remains one of the most prevalent contributors to cancer-related mortality worldwide. This study aims to evaluate biomarker expression in women with breast cancer and the correlations between them and other prognostic parameters. A retrospective analysis of 252 subjects was conducted at the Oncology Department of Mother Teresa University Hospital in Albania between 2021 and 2024. The highest rate of the disease was observed in the over-45 age group (92.5%). A family history of cancer was reported in 13.9% of patients. The most common histological type identified was ductal carcinoma (81.3%), which predominantly affected the left breast (57.1%) and was most frequently stage 2 (69.8%). A significant association (p < 0.001) was found between disease stage and expression of ER (Estrogen Receptors), PR (Progesterone Receptors), and HER2 (Human Epidermal Growth Factor Receptor 2), as well as between patient age and expression of ER, PR, and HER2 receptors (p = 0.02). HER2 and Ki-67 expression were inversely associated with ER and PR. Ki-67 was significantly correlated with age (p = 0.008) and stage (p < 0.001). Nodal metastasis correlated with Ki-67 (p = 0.02) and ER (p = 0.01).

Inpatient treatment in psychiatry is important due to several reasons, including stigma, cost, family support, admission indication, as well as availability of beds and other resources. In our setting, limited bed availability and challenges in inpatient services hinder the delivery of quality patient care. Therefore, information on the awareness, functionality, and needs of the inpatient services at our centre is imperative. This study aims to explore the clinicodemographic profile of psychiatric inpatients and examine their association with the length of hospital stay. This was a retrospective cohort study of all inpatients from June 2013 to May 2017. The clinicodemographic variables were recorded as per the developed proforma. We summarized the sociodemographic and other characteristics using median and proportions. To identify the factors with a significant impact on the length of stay, we performed multiple linear regression analyses. Of 1085 psychiatric inpatient records available, 1034 were included. The median length of stay was 8 days (Interquartile Range, 5 to 12 days). The patients with psychotic disorders and those receiving electroconvulsive therapy were more likely to have a longer length of stay by 30% and 146%, respectively. The overall length of stay was relatively short. However, the presence of psychotic disorders and the use of electroconvulsive therapy were associated with prolonged hospitalization.

IntroductionAwake craniotomy for removal of intra-axial tumors within or adjacent to eloquent brain regions is a well-established procedure, is routinely practiced to avoid anesthesia complication and other related cost. However, performing cartography, 3D printed of brain CT scans, use of neuronavigation for appropriate minimal craniotomy, brain stimulation, transoperative ultrasound and injection of tumour spy agent to discriminate tumour margins under surgical microscope fluorescence view is considered one of the best forms to improve quality of care.ObjectiveTo showcase benefits of awake craniotomy when combined with modern neurosurgical tools for tumour excision.MethodDescriptive analysis of 17 patients who underwent awake surgery protocol. Preoperative cartography, preoperative clinical psychology evaluation and transoperative identification of objects was done. The craniotomy was planned with neuronavigation. Trans-operative ultrasound, brain stimulation and injection of fluorescein under microscope fluorescence view were performed. CUSA aided tumor resection in some cases.FindingsWhen regional nerve blocks are successfully performed under ultrasound guidance, patients do not complain of pain during surgery. Patients underwent surgical intervention with complete macroscopic tumour excision. Minimal or no complications were recorded. All features improved post operatively. Patients were discharge between 2- 7 days following surgery and referred for adjuvant therapy. Better preservation of motor and speech functions, shorter hospitalization and reduced postoperative neurologic deficits were achieved.ConclusionAwake surgery with necessary modern neurosurgical tools help for total macroscopic tumour excision and improves patient survival. Adequate regional block is required for effective intraoperative pain control and better patient satisfaction. Appropriate patient selection, perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety and success. With the use of high technology equipment, the exact location of the lesions is possible through optimal keyhole craniotomy for tumour excision.

Colchicine has an excellent basis for being effective against COVID-19 due to its anti-inflammatory, immunomodulatory, and cardioprotective effects, as well as its role in preventing microvascular thrombosis. In addition, colchicine also has antiviral effects, an extremely favorable safety profile, and–since it does not exert any overt immunosuppressive activity–does not interfere with effective viral clearance, nor is it associated with the occurrence of secondary infections. However, all studies to date on the effects of low-dose colchicine for COVID-19 treatment are conflicting and rather disappointing. As colchicine has the remarkable ability to accumulate intensively in leukocytes–where the cytokine storm is generated–we initiated high but safe doses of colchicine for COVID-19 patient treatment. Our assumption was that a safe increase in colchicine dosage to reach micromolar concentrations in leukocytes would result in NLRP3 inflammasome/cytokine storm inhibition and would enhance its antiviral effect by inducing microtubule dissociation. Outpatients’ high-dose colchicine treatment practically prevents hospitalizations. Total colchicine uptake analysis demonstrates an inverse relationship with hospitalization. The duration of colchicine uptake also shows an inverse relationship with hospitalization and post-COVID-19 symptoms. Unlike the WHO-recommended antiviral preparations molnupiravir, remdesivir, and paxlovid, colchicine–in addition to its antiviral effect–prevents the cytokine storm and therefore has a strong effect not only in outpatients but also in inpatients. Unlike antivirals, colchicine significantly reduces post-COVID-19 symptoms. The side effects of colchicine are similar to those of paxlovid. The price of colchicine is incomparably lower, and it is also easily available.

Hyperemesis gravidarum (HG) is often associated with gestational transient thyrotoxicosis (GTT) due to elevated human chorionic gonadotropin (hCG) levels, affecting approximately 60% of HG patients. GTT is generally self-limiting, resolving by the first or early second trimester without requiring pharmacological treatment. We present the case of a 38-year-old pregnant woman, in her third pregnancy, who experienced severe nausea and vomiting at 6 weeks of gestation, with a Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) score of 12. Laboratory findings indicated low thyroid-stimulating hormone (TSH) and high free thyroxine (FT4), consistent with GTT, while thyroid ultrasound showed no abnormalities. The patient had a history of chronic hypertension since her first pregnancy and diabetes mellitus diagnosed a year earlier. Three weeks later, she was readmitted and diagnosed with thyrotoxic periodic paralysis (TPP) secondary to GTT. Treatment included intravenous fluids, potassium supplementation, antiemetics, vitamins, antithyroid drugs, and continued management of her diabetes and hypertension. HG, which is most common in the first trimester, is often linked to thyroid dysfunction due to hCG stimulation. While GTT is typically self-limiting, complications like TPP can arise, adding complexity to patient management, especially with coexisting conditions like diabetes and hypertension. Treatment strategies focused on symptom control, fluid rehydration, and careful adjustments of medications for thyroid, glycemic, and blood pressure management. Unfortunately, the patient did not return for follow-up, limiting further evaluation of her thyroid function in the second trimester. This case highlights the need for accurate diagnosis and timely intervention to prevent severe maternal and fetal outcomes, particularly in complex cases with multiple comorbidities.

Background: Duplex renal is a rare congenital anomaly of the urinary system, occurring in only 0.3–0.8% of the population. It is characterized by a duplicated collecting system within a single kidney. Most individuals remain asymptomatic, and the condition is often discovered incidentally during evaluation for unrelated urinary complaints such as urolithiasis. Anatomical variations in duplex systems can complicate diagnosis and management, particularly in cases involving kidney stones. This case report aims to highlight the diagnostic challenges and surgical approach in managing a large obstructive stone in an incomplete duplex renal system. Case Presentation: A 45-year-old woman presented with persistent left flank pain for one month. The physical examination showed tenderness at the left renal angle, while the laboratory findings were unremarkable. Abdominal ultrasound revealed severe hydronephrosis with a large nail-shaped stone in the left kidney. Ureteroscopy showed proximal bifurcation of the left ureter, and a double J stent was placed. Contrast-enhanced CT confirmed a bipelvic and biureteral system merging at S2, with a dilated upper collecting system and a 6.8 × 1.3 cm obstructive stone extending from the renal pelvis to the proximal ureter. Due to limited availability of minimally invasive tools, an open heminephroureterectomy was performed, removing the non-functioning upper moiety filled with pus and the stone. Postoperative recovery was uneventful. Conclusion: The management of nephrolithiasis in duplex renal systems requires tailored strategies based on anatomical variations, available resources, and stone characteristics. In this case, open surgery provided a definitive solution for both stone removal and excision of the non-functional renal segment.