Multiple mini-interviews is a predictor of students' academic achievements in early undergraduate medical years: a retrospective study.

BACKGROUND: Our study determined Multiple Mini-Interview (MMI) effectiveness in evaluating specific skill sets based on medical students' performances during the undergraduate years and compared the academic performances of medical students who appeared for onsite/online MMI. METHODS: A retrospective study of 140 undergraduate medical students between 2016 and 2020 included data on age, gender, pre-university results, MMI scores, and examination results. Appropriate non-parametric tests were applied to compare the students' MMI and academic performances. RESULTS: Ninety-eight students from cohorts 12 to 15 had an overall MMI score of 69.0(IQR: 65.0-73.2)/100 and an overall Cumulative Grade Point Average(GPA) of 3.64 (3.42-3.78)/5.0. Spearman's correlation revealed a significantly positive relationship between MMI and cGPA (rho = 0.23) and GPA from the first 2 semesters (GPA1 rho = 0.25, GPA2 rho = 0.27). This observation was similar to that for station A in the first year (cGPA rho = 0.28, GPA1 rho = 0.34, GPA2 rho = 0.24), and in station B (GPA4 rho = 0.25) and D (GPA3 rho = 0.28, GPA4 rho = 0.24) in the second year. Of twenty-nine cohort16 students, 17(58.6%) underwent online and 12(41.4%) offline modes of MMI assessment, respectively. The overall median MMI score was 66.6(IQR: 58.6-71.6)/100, and the overall median cGPA was 3.45 (3.23-3.58)/5.0. When comparing the median marks of cohort16 groups, the online group scored significantly higher marks for station D than the offline group (p = 0.040). CONCLUSION: Correspondence between MMI scores and cGPA predicted MMI scoring during student selection and entry process might ensure the success of their academic performance in medical school.

Breast paraffinoma: An obsolete but still important condition - Experience with 60 cases and the literature review.

BACKGROUND: Paraffin injections for breast augmentation has been abandoned by clinicians because of its serious long-term complications. The practice is still prevalent and long-term complications are still being encountered in clinical practice today. METHODS: Retrospective review was performed on patients with breast paraffinoma managed in Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam, between January 1, 2010 and August 31, 2020. Patients' demographics, presentations, investigations, treatment and follow-up outcomes were reviewed. A literature review on breast paraffinoma was also performed. RESULTS: We reviewed the data by combining our dataset of 60 patients with those extracted from the published articles, totaling 232 patients from 31 articles. The mean age at presentation was 48.8 (range 29-78) years with a preponderance of female patients. The most common presenting symptoms were painless lumps (65.5%), painful lumps (14.7%), ulcer (7.3%), skin discoloration (2.4%), sinus (1.7%) and abscess (1.0%). The most common imaging modality used was mammography (70.7%), MRI (52.6%) and ultrasonography (47.8%). Majority of the reported cases underwent surgical treatment; mastectomy was performed in 53.4% of the cases, excision of the paraffinoma in 17.7% of cases and 0.9% of cases had incision and drainage. A quarter of the patients (25%) did not require any further treatment. The mean follow-up was 4 (range 1-10) years with a mortality rate of 3.0%. CONCLUSIONS: Awareness of this condition will assist the clinicians in making the correct diagnosis and instituting the appropriate treatment. It is important to exclude co-existing breast cancer.

KRAS Mutation: Characterization and Its Impact on Survival Outcome of Patients with Metastatic Colorectal Cancer.

INTRODUCTION: Colorectal cancer (CRC) is one of the most common cancer types, with rising incidence due to imbalanced lifestyle and dietary habit. Association between CRC cases and KRAS mutation has been established recently. Brunei Darussalam, located within the Borneo island, is of diverse ethnicity which could represent the genome of Southeast Asia population. Our study, for the first time, determined the survival outcome of metastatic colorectal cancer (mCRC) and established the link with KRAS mutation by modelling the population in Brunei Darussalam. METHODS: We collected data of 76 metastatic CRC (mCRC) patients undergoing treatment at The Brunei Cancer Centre, the national centre for cancer treatment in Brunei. These patients were diagnosed with Stage 4 CRC between 1 January 2013 and 31 December 2017. Age, gender, ethnicity, date of diagnosis, site of primary tumour, metastatic sites and molecular analysis of KRAS mutation status (either KRAS mutated or KRAS wild-type) of tumour were recorded. The survival outcomes of these mCRC patients were analysed. RESULTS: The end of this study period recorded 73.1% deceased mutant KRAS mCRC patients and 46.0% deceased wild-type KRAS mCRC patients, contributing to death rates of 45.2% and 54.8%, correspondingly. Chi-squared analysis showed a significant difference between the survival outcomes of wild-type KRAS and mutant KRAS mCRC patients (p-value = 0.024). CONCLUSIONS: There is a significant difference between the survival outcomes of wild-type KRAS and mutant KRAS mCRC patients in the Brunei population. In addition, we found that mutations in codon 12 of KRAS gene on mutant KRAS mCRC patients have shorter survival median periods than those with mutations within codon 13 of KRAS gene. This is the first study in Brunei Darussalam to analyse both the survival outcomes of mCRC patients and those of mutant KRAS mCRC patients.

The risk of pressure ulcers in a proned COVID population.

The utilisation of prone positioning has been vital during the COVID-19 pandemic, however risks the development of anterior pressure ulcers. An observational study was performed to examine the prevalence of pressure ulcers in this population and define risk factors. Eighty-seven patients admitted to critical care were studied. Of 62 patients with >1 day in prone position, 55 (88.7%) developed anterior pressure ulcers, 91% of which were anterior. The most commonly affected site were the oral commisures (34.6%), related to endotracheal tube placement. Prone positioning (p < .001) and the number of days prone (OR 3.11, 95% CI 1.46-6.62, p = 0.003) were a significant risk factors in development of an anterior ulcer. Prone positioning is therefore a significant cause of anterior pressure ulcers in this population.

Fine-Needle Aspiration Cytology in the Diagnosis of Breast Paraffinoma.

INTRODUCTION: Paraffin injections for breast augmentation once a popular form of mammoplasty are now considered obsolete. It had been abandoned by clinicians because of its associated serious complications. The practice is however still available and is being practiced by nonmedically qualified people. Paraffin injection results in the formation of multiple foreign-body granulomas known as breast paraffinoma. The clinical features of breast paraffinoma can mimic and be mistaken for breast carcinoma or inflammatory breast carcinoma. The use of fine-needle aspiration cytology (FNAC) in the evaluation of patients with breast paraffinoma has not been fully evaluated. METHODS: Retrospective review was performed on 30 patients who presented with breast paraffinoma between June 1, 2010, and June 30, 2020, who also had FNAC as part of their breast lump evaluation. RESULTS: FNAC of 73.3% patients showed multinucleated giant cells and macrophages or histiocytes containing engulfed clear, empty intracytoplasmic vacuoles of varying sizes. In 13.3% of the patients, macrophages or histiocytes with engulfed clear intracytoplasmic vacuoles of varying sizes were seen. In 6.7% of patients, multinucleated giant cells containing engulfed vacuoles of varying sizes were seen, and in 6.7% of patients, hypocellular smears with large amount of clear spaces were seen. Oily droplets were seen in the background of all the smears, and there were no malignant cells seen. These features were compatible with breast paraffinoma. CONCLUSION: Most patients with breast paraffinoma can be managed conservatively and they do not require further treatment; FNAC with its characteristic features can provide the reliable diagnosis of breast paraffinoma and therefore sparing these patients from more invasive diagnostic procedures.

Kimura's disease: a rare cause of chronic neck lymphadenopathy.

Kimura's disease is a rare chronic inflammatory disorder of unknown etiology which typically presents with subcutaneous nodules in the head and neck region and is frequently associated with regional lymphadenopathy or salivary gland enlargement. Peripheral blood eosinophilia and elevated serum immunoglobulin E levels are constant features of the disease. We present herein a 31-year-old male patient who presented with chronic neck lymphadenopathy. Kimura's disease was diagnosed on fine needle aspiration cytology, the patient initially decided not to have further intervention. He presented 6 years later with lymphadenopathy and was treated with surgery. The diagnosis of Kimura's disease was confirmed on histopathology. This patient had the disease for 6 years and did not have the typical features of peripheral eosinophilia and raise serum IgE level.

Conducting multiple mini-interviews in the midst of COVID-19 pandemic.

Multiple mini-interview (MMI) is a 'multiple sample-based' approach comprising multiple focused encounters intended to access and assess a range of attributes in order to gain more objectively multiple impressions of an applicant's interpersonal skills, thoughtfulness and general demeanour. It is designed to focus on four domains that are not considered to be comprehensive, but are considered to be vital for a successful career in the health sciences: critical thinking, ethical decision making, communication and knowledge of the healthcare system. Traditionally, the MMI is conducted face-to-face, but with COVID-19 pandemic and the implementation of social distancing measures, no onsite or campus teaching, banning of mass gatherings and cancellation of face-to-face interviews, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences at Universiti Brunei Darussalam explored the feasibility of conducting MMI through virtual means. This report provides an account of our experience in conducting internet-MMI for the selection of new applicants into the August 2020 cohort of the Medicine programme. We also aimed to determine whether the scores derived from internet-MMI were reliable and equivalent to the scores derived from traditional MMI.

Fluorescence in situ hybridisation analysis of human epidermal growth factor receptor 2 status for breast cancer cases in Brunei Darussalam.

BACKGROUND: Breast cancer is one of the leading cancers among females of Brunei Darussalam. There are four subtypes of breast cancer, including human epidermal growth factor receptor 2 (HER-2) positive breast cancer, which is known to be more aggressive and have a poor prognosis. AIM: This study aims to assess the proportion of HER-2 positive cases and the association of HER-2 positivity with patients' epidemiological and clinicopathological factors in Brunei Darussalam. METHODS AND RESULTS: A total of 146 breast cancer cases that were sent for fluorescence in situ hybridisation (FISH) analysis from 1 January 2012 to 31 December 2016 were obtained from The Brunei Cancer Centre, Brunei Darussalam. Data analysis was done with regards to age at diagnosis, ethnicity, stage at diagnosis and HER-2 results by immunohistochemistry (IHC) and FISH. Majority of the study population were diagnosed before the age of 50 years and the median age was 52.0 years. 58.2% (n = 85) cases were reported as IHC 3+, followed by 23.3% (n = 34) IHC 2+ cases and 18.5% (n = 27) negative cases. The proportion of true HER-2 positive cases in total by FISH analysis was 34.9% (n = 51). Majority of Stage IV HER-2 positive cases had metastases to the liver or bones. CONCLUSIONS: Age at diagnosis is significant in determining HER-2 status of tumours by FISH (P = .045). Tumour size (P < .001) and lymph node (P = .006) are significant in metastases of tumours. The proportion of HER-2 positive cases is consistent with findings from the Asian region but higher than that of Western countries. Determining false-positive and false-negative results by IHC test is important to ensure adequate treatment for patients with breast cancer.

COVID-19: A Reminder for Medical Curriculum Review.

Medical schools must ensure that their curricula evolve in response to changes in clinical practice and the needs of future doctors. Undergraduate medical programs should be better equipped to anticipate and plan for changes in future clinical practice and learning needs of the students. The COVID-19 outbreak and the recent epidemics of new and emerging infections have brought into sharp focus the importance of subjects, such as infectious diseases, infection control, public health, occupational health and virology in medical school curricula. A review of the medical curriculum at PAPRSB Institute of Health Sciences revealed that the time allotted for teaching these subjects is much less than that allotted for teaching non-communicable diseases and other subjects. The changing health paradigm requires medical teaching to be continuously redefined and updated. Given the reduced amount of teaching time allotted for subjects, such as infectious diseases, infection control, public health, occupational health and virology, it might be timely to review and recalibrate the teaching hours of these subjects in all the medical curricula, to better prepare our doctors facing the challenges of future epidemics and pandemics.

2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting.

Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.

SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma.

Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (90Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P < .001). The most common grade ≥ 3 AEs were ascites (five of 130 [3.8%] v four of 162 [2.5%] patients), abdominal pain (three [2.3%] v two [1.2%] patients), anemia (zero v four [2.5%] patients), and radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.

Raising concerns about the Sepsis-3 definitions.

The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting.

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.

A proposal for a CT driven classification of left colon acute diverticulitis.

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.

Extrahepatic biliary cystadenoma: a rare cause of biliary obstruction.

Biliary cystadenoma is a rare tumor of the biliary tree and a rare cause of obstructive jaundice. Most are intrahepatic, and pure extrahepatic biliary cystadenoma is less common. Cases are more common in women. Unless suspected, diagnosis of extrahepatic biliary cystadenoma is often delayed. Here, we report the case of a young woman with extrahepatic biliary cystadenoma who presented at Raja Isteri Pengiran Anak Saleha Hospital with obstructive jaundice initially thought to be due to a large biliary stone based on the endoscopic cholangiogram image. She was successfully managed with resection of the cystadenoma.

World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections.

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

WSES guidelines for emergency repair of complicated abdominal wall hernias.

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study).

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18-98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

2013 WSES guidelines for management of intra-abdominal infections.

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.