PSU Medical Journal

The Largest Phyllodes Breast Tumor in The World: A Case Report

Suphawat Laohawiriyakamol — 2024-08-23

Phyllodes tumor of the breast is an uncommon fibroepithelial neoplasm constituting 0.3% to 0.5% of female breasttumors. Complete wide local excision is frequently used for treatment and risk reduction in local recurrence. This article aims to report the largest phyllodes breast tumor ever reported worldwide. We report the case of a 24-year-old Thai woman was admitted to our hospital with a massive ulcerofungating right breast mass. Her physical examination revealed a 59 cm diameter mass over her right upper body, in which most parts were infected and ulcerated. A right mastectomy was then performed after the patient had already been treated with intravenous antibiotics for infection control and when her nutrition status had improved. This was followed by Vacuum-Assisted closure of the wound, and split-thickness skin graft, which could be performed after there was a good granulation growth at the wound base. Additionally, after histopathology examination, a 59x53x26 cm malignant Phyllodes tumor with free margins, weighing 14,500 grams, in which there was around 20% tumor necrosis, 12/10 high power fields (HPFs) of Mitosis, and the unaffected nipple was observed. The patient was discharged from the hospital after 45 days, and there was no evidence of local and distant recurrence after a one-year follow-up. Phyllodes tumors are considered unusual fibroepithelial breast tumors that have various biological behaviors, in which surgical resection is a major option for treatment.

Association Between Time to Colonoscopy After Abnormal Fecal Immunochemical Test and Risk of Adenoma, Advanced Colorectal Neoplasia and Colorectal Cancer Incidence

Amorn Sankhaanurak — 2024-08-23

Objective: Colorectal cancer (CRC) is a significant health concern in Thailand, with high incidence and late-stage diagnosis rates. This study investigates the timing of colonoscopy following a positive fecal immunochemical test (FIT) and identifies risk factors for colorectal neoplasms.
Material and Methods: A retrospective analysis included Thai patients aged 50-75 with a positive FIT who underwent colonoscopy. Exclusions were made for prior colonoscopy, colorectal surgery history, hereditary syndromes, inflammatory bowel disease, and incomplete pathology reports. Data from January 2018 to December 2021 were assessed for demographics, colonoscopy findings, and pathology outcomes.
Results: The study encompassed 2,717 participants with balanced age and gender distributions. Preliminary risk factors associated with the development of adenoma and advanced colorectal neoplasia (ACRN) included age [odds ratio (OR): 1.03, 95% confidence interval (CI): 1.02-1.05, p-value<0.001], gender (OR for males: 1.60 for adenoma, 1.69 for ACRN, p-value<0.001), and smoking (OR: 1.92, p-value=0.001). The timing of colonoscopy within one-year post-FIT did not exhibit statistically significant associations with adenoma, ACRN, or CRC.
Conclusion: This study provides valuable insights into CRC screening in Thailand. It suggests that timing within a year of colonoscopy might not be the sole determinant of improved outcomes post-FIT. Preliminary risk factors encompassed age, gender, and smoking. Future studies should focus on larger cohorts to investigate adverse outcomes, such as late-stage CRC and CRC-related mortality.

Variations in the Association between Economic Distress and Anxiety by Availability of Emergency Cash Reserves: Findings from a Longitudinal Study

Wit Wichaidit — 2024-08-23

Objective: 1) to describe the extent that experience of economic distress is associated with incidence of anxiety, and; 2) modification of the mentioned association by availability of emergency cash reserves.
Material and Methods: We conducted a longitudinal study using two phone-based surveys in the general population of Thailand in April and May, 2021. We analyzed data using descriptive statistics and log-binomial regression analyses.
Results: There were 1135 persons who met the inclusion criteria and participated in both surveys (non-participation at baseline=31.7%; loss-to-follow-up=420/1555=14.4%). The association between economic distress and anxiety was stronger among participants with no emergency cash reserves (Adjusted RR=2.05, 95% CI=0.86, 4.90) and more moderate among participants with emergency cash reserves (Adjusted RR=1.70, 95% CI=0.31, 9.43).
Conclusion: The study results appeared to support our hypothesis despite lack of statistical significance. However, the lack of adjustment for other predictors of anxiety, and the lack of ability to generalize to other phases of the COVID-19 pandemic should be considered as caveats in the interpretation of our study findings.

Predictive Analysis of Clinical Pharmacist Talent Demand in Yunnan: A Grey GM(1,1) Model Approach with Insights from Kunming Medical University

Pengxiao Yang — 2024-08-23

Objective: Leveraging the Grey GM(1,1) model, we aimed to forecast the clinical pharmacist demand in Yunnan province. This was done using Kunming Medical University as a case study to inform effective talent cultivation strategies.
Material and Methods: Historical demographic and educational data from Yunnan informed our Grey GM(1,1) model to predict future demands for clinical pharmacists accurately.
Results: The population of Yunnan peaked at 46.53 million in 2014, experienced a slight decline in 2015, and then increased to 46.93 million in 2022. Concurrently, enrollment plans for clinical pharmacists at higher medical colleges are projected to grow, with an anticipated intake of 114 students in 2023. Despite this growth, and considering Yunnan’s aging demographic, there is an emerging demand for 3,000 clinical pharmacists by 2027, with a forecasted shortfall of 1,250 personnel.
Conclusion: To address this significant gap, it is crucial to refine the clinical pharmacy curriculum at Kunming Medical University, by incorporating more hands-on experiences and strengthening collaborations with clinical medical institutions to enhance practical training opportunities for students.

Common Adverse Events from Chemotherapy in Ambulatory Gynecologic Cancer Care

Nungrutai Saeaib — 2024-08-23

Chemotherapy alone or as an additive treatment with surgery or radiation is the most common treatment in 70% of gynecologic cancers and the majority of patients in the ambulatory unit. The most common chemotherapy adverse events are divided into those occurring in the hematologic and non-hematologic systems. In the hematologic system, anemia and thrombocytopenia are treated with blood component transfusions, packed red cells and platelets, respectively. Neutropenia, especially febrile neutropenia, is the major cause of severe infection in patients, and may lead to death, Granulocyte colony-stimulating factor is used for primary or secondary prophylaxis depending on the febrile neutropenia risk of chemotherapy and patients’ risk. In the non-hematologic system, nausea, vomiting, fatigue, alopecia, hand-foot syndrome, hypersensitivity and peripheral neuropathy are the main adverse events. Premedication before chemotherapy administration is an effective method for preventing nausea and vomiting and decreased the incidence of hypersensitivity, which can be a life-threatening event, while other symptoms such as fatigue, alopecia, hand-foot syndrome and peripheral neuropathy require only symptomatic treatments.

The Rise of Artificial Intelligence in Thai Medicine: A New Era of Possibilities

Surasak Sangkathat — 2024-08-23