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Fulltext EXIT Llyod Davies

Mohd Faizal, A., Vijayan, V., Sandhya, M.M., Noor Shahieddah, F., Vinod, S., Tan, L.K., et al.

Journal of Surgical Academia, 2015;5(1):71-74.
MyJurnal

The EXIT (Ex utero intrapartum treatment) procedures have been, with a high degree of success, employed to treat a myriad types of fetal airway obstruction most commonly neck masses such as cystic hygroma and lymphangioma with ample plan including prenatal diagnosis by ultrasound scan or MRI. Before the advent of EXIT, formal documentations had been published with descriptions of intubation during intrapartum period and fetal airway protection either during normal or operative delivery. We report a 28-year-old gravida 2 para 1 who was referred to our Maternal Fetal Medicine (MFM) unit at 26 weeks and 3 days gestation with a foetal neck mass. We present a case of an successful EXIT procedure performed in the Lloyd Davies position with the hips abducted and flexed at 15 degrees as is employed during gynecologic laparoscopy surgery minus the Trendelenburg tilt. Both mother and baby are well. The benefits of this position are discussed.
Fulltext A pure nongestational choriocarcinoma of ovary: sharing experience in Sabah

Mohd Faizal, A., Dianie, D.J.K., Suguna, S., Soon, R., Moharzudi, M.

Journal of Surgical Academia, 2015;5(1):51-53.
MyJurnal

A pure ovarian choriocarcinoma is a very rare disease which can be either pregnancy related (gestational), may not be related (non-gestational), or commonly correlated with different type of germ cell; teratocarcinoma, dysgerminoma or undifferentiated carcinoma. A pure non-gestational primary ovarian choriocarcinoma is astronomically uncommon and we recorded such condition in 14-year-old teenage girl’s ovary. An abdominal operative procedure with the help of a careful histopathology examination revealed choriocarcinoma in absence of other type of germ cell element. Multiple courses of Etoposide/Methotrexate/Actinomycin-D (EMA) regime of chemotherapy were shown to be effective in this case.
Knowledge, attitudes, and communication around human papillomavirus (HPV) vaccination amongst urban Asian mothers and physicians

Chow SN, Soon R, Park JS, Pancharoen C, Qiao YL, Basu P, et al.

Vaccine, 2010 May 14;28(22):3809-17.
PMID: 20347631 DOI: 10.1016/j.vaccine.2010.03.027

To determine why HPV vaccination uptake is low in Asia, we surveyed attitudes, knowledge and communication about cervical cancer and HPV vaccination amongst 480 physicians and 1617 randomly selected urban mothers who could afford HPV vaccines in Korea, Malaysia, Taiwan and Thailand. HPV vaccine rejection by mothers was linked with poor knowledge and low perceptions of self-relevance. Physicians' likelihood of raising the subject and/or recommending vaccination was linked to how proactively they advocate preventive health, their attitude to the subject's sensitivity and their knowledge levels. Because most Asian mothers seek doctors' advice and prefer them to take the initiative, physicians should be more proactive in discussing and recommending HPV vaccination.
Comparative Cost-Effectiveness Analysis of Two Different Two-Dose Human Papillomavirus Vaccines in Malaysia

Van Kriekinge G, Sohn WY, Aljunid SM, Soon R, Yong CM, Chen J, et al.

Asian Pac J Cancer Prev, 2018 Apr 25;19(4):933-940.
PMID: 29693347

Purpose: To comparatively evaluate the results of a 2-dose human papillomavirus (HPV) vaccination programme
with the AS04-adjuvanted HPV16/18 vaccine (AS04-HPV-16/18v) or HPV-6/11/16/18 vaccine (4vHPVv), in addition
to cervical cancer (CC) screening, in Malaysia. Methods: A lifetime Markov model replicating the natural history of
HPV in 13-year-old girls was adapted to Malaysia to assess the impact of vaccination on pre-cancerous lesions, genital
warts and CC cases, CC deaths, quality-adjusted life years (QALYs), and costs from the perspective of the Malaysian
Ministry of Health. Vaccine effectiveness was based on efficacy and HPV type distribution. Both vaccines were assumed
to have equal efficacy against vaccine-type HPV but differed for protection against non-vaccine types. Vaccine price
parity was used and health and cost outcomes were discounted at 3%/annum. Sensitivity analyses tested the robustness
of the results. Results: The model predicted that AS04-HPV-16/18v would result in 361 fewer CC cases and 115 fewer
CC deaths than 4vHPVv, whereas 4vHPVv averted 4,241 cases of genital warts over the cohort’s lifetime. Discounted
total costs showed savings of 18.50 million Malaysian Ringgits and 246 QALYs in favour of AS04-HPV-16/18v. In
one-way sensitivity analyses, the discount rate was the most influential variable for costs and QALYs, but AS04-HPV-
16/18v remained dominant throughout. A two-way sensitivity analysis to assess the longevity of cross-protection for both
vaccines confirmed the base-case. Conclusions: In Malaysia, the use of AS04-HPV-16/18v, in addition to screening,
was modelled to be dominant over 4vHPVv, with greater estimated CC benefits and lower costs.
Impact of Long-Term Dienogest Therapy on Quality of Life in Asian Women with Endometriosis: the Prospective Non-Interventional Study ENVISIOeN

Techatraisak K, Hestiantoro A, Soon R, Banal-Silao MJ, Kim MR, Seong SJ, et al.

Reprod Sci, 2022 Feb 02.
PMID: 35112299 DOI: 10.1007/s43032-021-00787-w

Several clinical trials in women with endometriosis demonstrated that dienogest reduces endometrial lesions and improves health-related quality of life (HRQoL). To assess HRQoL in dienogest-treated patients in real-world setting, we conducted a prospective, non-interventional study in 6 Asian countries. Women aged ≥18 years with clinical or surgical diagnosis of endometriosis, presence of endometriosis-associated pelvic pain (EAPP) and initiating dienogest therapy were enrolled. The primary objective was to evaluate HRQoL using the Endometriosis Health Profile-30 (EHP-30) questionnaire. The secondary objectives included analysis of EAPP, satisfaction with dienogest, endometriosis symptoms and bleeding patterns. 887 patients started dienogest therapy. Scores for all EHP-30 scales improved with the largest mean changes at month 6 and 24 in scale pain (-28.9 ± 27.5 and - 34 ± 28.4) and control and powerlessness (-23.7 ± 28.2 and - 28.5 ± 26.2). Mean EAPP score change was -4.6 ± 3.0 for both month 6 and 24 assessments. EAPP decrease was similar in surgically and only clinically diagnosed patients. From baseline to month 24, rates of normal bleeding decreased (from 85.8% to 17.5%) while rates of amenorrhea increased (from 3.5% to 70.8%). Majority of patients and physicians were satisfied with dienogest. Over 80% of patients reported symptoms improvement. 39.9% of patients had drug-related treatment-emergent adverse events, including vaginal hemorrhage (10.4%), metrorrhagia (7.3%) and amenorrhea (6.4%). In conclusion, dienogest improves HRQoL and EAPP in the real-world setting in women with either clinical or surgical diagnosis of endometriosis. Dienogest might be a promising first-line treatment option for the long-term management of debilitating endometriosis-associated symptoms.NCT02425462, 24 April 2015.
Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical intraepithelial neoplasia across 5 countries in Asia

Quek SC, Lim BK, Domingo E, Soon R, Park JS, Vu TN, et al.

Int. J. Gynecol. Cancer, 2013 Jan;23(1):148-56.
PMID: 23221730 DOI: 10.1097/IGC.0b013e31827670fd

OBJECTIVE: Independent, prospective, multicenter, hospital-based cross-sectional studies were conducted across 5 countries in Asia, namely, Malaysia, Vietnam, Singapore, South Korea, and the Philippines. The objectives of these studies were to evaluate the prevalence of human papillomavirus (HPV) types (high risk and others including coinfections) in women with invasive cervical cancer (ICC) and high-grade precancerous lesions.
METHODS: Women older than 21 years with a histologic diagnosis of ICC and cervical intraepithelial neoplasia [CIN 2 or 3 and adenocarcinoma in situ (AIS)] were enrolled. Cervical specimens were reviewed by histopathologists to confirm the presence of ICC or CIN 2/3/AIS lesion and tested with short PCR fragment 10-DNA enzyme immunoassay-line probe assay for 14 oncogenic HPV types and 11 non-oncogenic HPV types. The prevalence of HPV 16, HPV 18, and other high-risk HPV types in ICC [including squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (ADC/ASC)] and CIN 2/3/AIS was estimated.
RESULTS: In the 5 Asian countries, diagnosis of ICC was confirmed in 500 women [SCC (n = 392) and ADC/ASC (n = 108)], and CIN 2/3/AIS, in 411 women. Human papillomavirus DNA was detected in 93.8% to 97.0% (84.5% for the Philippines) of confirmed ICC cases [94.0%-98.7% of SCC; 87.0%-94.3% (50.0% for the Philippines) of ADC/ASC] and in 93.7% to 100.0% of CIN 2/3/AIS. The most common types observed among ICC cases were HPV 16 (36.8%-61.3%), HPV 18 (12.9%-35.4%), HPV 52 (5.4%-10.3%), and HPV 45 (1.5%-17.2%), whereas among CIN 2/3/AIS cases, HPV 16 (29.7%-46.6%) was the most commonly observed type followed by HPV 52 (17.0%-66.7%) and HPV 58 (8.6%-16.0%).
CONCLUSIONS: This article presents the data on the HPV prevalence, HPV type distribution, and their role in cervical carcinogenesis in 5 Asian countries. These data are of relevance to public health authorities for evaluating the existing and future cervical cancer prevention strategies including HPV-DNA testing-based screening and HPV vaccination in these Asian populations.