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    Tykf-Aabmss Monthly Medical Forum 265-270

    9/9/2015

     
    Every month, the Tan Yan Kee Foundation, Inc. and the Association of Asia Brewery Medical Specialty Scholars (AABMSS) hold a medical forum designed for laymen. The forum provides people with a venue to learn about the latest medical issues, trends, and available treatment options.  Asia Brewery medical scholars render free consultations and discuss pertinent matters in layman’s language.  The forum is held at the Century Park Sheraton.

    Medical Forum No. 265
    Breast Conservation Surgery for Early Breast Cancer
    Derrick Chua, M.D.
    January 12, 2015

    Breast Cancer: Second most common life-threatening cancer in women

    Risk Factors:
     Prolonged estrogen exposure (hormone replacement and oral contraceptive)
    Heredity or genes
    Sedentary lifestyles

    Prevention:
    Lifestyle Change.
    Early breastfeeding
    Avoid adult weight gain
    Limit use of hormone replacement and oral contraceptive 
    Limit alcohol intake
    Regular exercise
    Medication (Tamoxifen/Raloxifene/Exemestane) or Surgery

    Diagnosis:
    Breast Self-Examination
    Genetic Profiling with Micro-arrays
     Magnetic Resonance Imaging (MRI)
    Clinical Breast Exam
    Biopsy
    Mammography
    Sonomammography

    Classifications:
    Anatomic Staging:
    I: Confined to Breast
    II: Early Lymph node spread
    III: Advanced
    IV: Metastatic
    Pathologic: Invasive ductal carcinoma is most common
    Molecular:

    Luminal A: Most common in age 70’s
    Luminal B
    Her2 non-luminal 
    Basal-like: Most aggressive type and is linked to ovarian cancer


    Treatment:
    Surgery: for early cancer
    Breast Conservation Therapy: Removal of tumor plus radiotherapy
    Mastectomy: Removal of breast with or without reconstruction 
    Axillary Dissection: Biopsy of Sentinel lymph node subsequently comprehensive node removal with or without radiotherapy
    Outright Axillary Dissection: Higher risk of arm swelling

    Adjunctive Therapy:
    Radiotherapy: Loco regional treatment for the remaining breast or depending on stage of cancer 
     Hormonal Therapy: Response predicted by hormone receptors assays
    Tamoxifen: Most affordable
    Aromatase Inhibitors: More effective for postmenopausal
    Chemotherapy: Combinations of agents given  for early stage but molecularly aggressive subtypes

    Targeted Therapy: 
    Herceptin (Traztuzumab) and similar antibodies to tested molecular targets: very expensive but effective
    Meditation, Yoga, Stress management: Supportive care that improves mood, fatigue and quality of life

    Follow-ups:
    Twice a year physical exam for 5 years, yearly mammogram and with gynecology exam if on Tamoxifen
    Other tests (e.g. chest x-ray) depends on symptoms


    Medical Forum No. 266
    Updates on Allergic Rhinitis
    Johanna Co, M.D.
    February 9, 2015

    Allergic Rhinitis: Common form of Chronic non-infectious inflammatory rhinitis caused by high lgE level

    Symptoms: Come and go but inflammatory will persist

    Sneezing
    Rhinorrhea
    Nasal itch
    Puffy eye bags
    Nasal obstruction 
    Nasal creases
    Denny Morgan lines
    Clear and not muco-purulent mucus

     Risk Factors: 

    Pets
    Pollens
    Cockroach
    Industrial Pollution
    Indoor environment
    Lifestyle change
    Molds
    Stress
    Genetic
    House dust mites
    Exposure to new allergens

    Diagnosis:

    n Skin allergy test

    n Total IgE

    n Fiberoptic rhinoscopy 

    n CT scan




    Complications (if left unthreatened): 

    n Asthma

    n Dermatitis

    n Sinusitis

    n Polyposis

    n Upper respiratory tract infection

    n Conjunctivitis 

    n Otitis media

    Treatment:

    n Avoidance of allergens

    n Oral Antihistamines

    n Intranasal and oral corticosteroids: good but have side effects in some cases

    n Anti-leukotrienes

    n Oral and Intranasal Decongestants




    Medical Forum No. 267

    Approach on 

    Diabetic Foot

    Luinio S.Tongson, M.D.

    March 2, 2015




    Foot Ulcer: A non-healing or poorly healing full thickness wound, through the dermis, below the ankle in an individual with diabetes, critical in the natural history of the diabetic foot. 

    60-70% of diabetes patients will develop peripheral neuropathy, or lose sensation in their feet.

    More than 50% of all foot wounds require hospitalization, 20% will require an amputation.

    People with a history of diabetic foot ulcer have 40% 10 year mortality.




    Treatment of Diabetic Foot Ulcers:

    n Determine its severity, vascularity and infection.

    Wagner Classification: most widely used grading system

    n Grade 0: No ulcer in a high risk foot.

    n Grade 1: Involves full skin thickness

    n Grade 2: Penetrate ligaments and muscle, but no bone involvement. 

    n Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis.

    n Grade 4: Localized gangrene.

    n Grade 5: Extensive gangrene involving the whole foot.

    n Obtain wound closure

    n Allow prompt healing of the lesion

    n Prevent recurrence and amputation

    Focus of Management Programs:

    n Prevention

    n Aggressive Intervention

    n Education

    n Optimal Use of Therapeutic Footwear

    n Regular Foot Examinations




    Medical Forum No. 268

    Overcoming Barriers and Optimizing Care for Children with ADHD and Autism

    Elizabeth Go-Tan, M.D.

    April 13, 2015




    Developmental and Behavioral Disorders: Children who have developmental delays or behave in ways that seem very different from others.

    New physical stimulus, perception, and reaction may cause fear, anxiety and discomfort that may significantly affect children’s social, play and participation in daily lives.

    A kind of chronic pediatric conditions causing functional impairment, and is common than childhood cancers or cardiac and renal problems.

    Attention deficit hyperactivity disorder (ADHD): most common neurobehavioral disorder seen in children ages 4 to 18.

    Symptoms: Inattention, hyperactive or impulsive, academic or behavioral problems.

    Childhood Autism Spectrum Disorder (ASD): Children with difficulty in social interaction and communication; restricted interest or repetitive motor behavior or activity.

    Evaluation: Primary care Physicians should routinely perform developmental and behavioral screening at regular intervals

    Developmental Screening Tools: Aid in identifying disordered expressive and receptive language; deficits in gross and fine motor skills, self-help skills, and cognitive milestones.

    General Development: Use standardized validated tools at9,18.24, or 30 months

    ASD: at 18 and 24 months or whenever a parent or caregiver has concern

    Behavioral and Emotional Screening Tools: help identifies problems like social-emotional regulation, attention, changes in mood and affect, and interpersonal skills.

    Parents and caregivers should not only depend on the screening results, but should also observe closely on child’s behavior and overall development. 

    Health professionals should carefully listen and attend to their concerns, to ensure proper management and early intervention to take place without delay. 




    Medical Forum No. 269

    Dengue Myocarditis

    James L. Angtuaco, M.D.

    May 11, 2015




    Dengue: A common mosquito-borne disease that can cause thrombocytopenia (abnormally decrease in the number of blood platelets)

    Types:

    n Symptomatic: fever, headache, decreased appetite, vomiting, joint muscle aches 

    n Asymptomatic: Experiencing no symptoms at all

    Diagnosis:

    n Blood Examination: To observe the number of platelets in the blood

    Treatment:

    Intravenous Fluids: Mainly treat symptoms and also aims to prevent dengue shock




    Dengue Shock Syndrome: Acute, severe and potentially deadly stage caused by the spread dengue virus to the circulatory system or other vital organs

    Treatment: use of Intravenous Fluids




    Myocarditis (inflammation of heart muscles): One of the possible causes of dengue shock and its symptoms may also be present in asymptomatic dengue patients

    Symptoms: Chest pain, Short breath, fatigue, fluid accumulation in the lungs, heart rhythm irregularities (bradycardia or slow heart rate)

    Treatment: 

    n Intravenous Fluids

    n Inotropes

    n Cardiac Support

    n Course or Management: benign  or mild type but favorable to treatment

    Prognosis: Poor

    Adolescent: Dilated Cardiomyopathy (heart becomes weakened and enlarged and can’t pump blood efficiently)

    Adult: Still unknown




    Medical Forum No. 270

    Allergic Rhinitis, Asthma and Sinusitis: How Are They Linked?

    Nanneth Tiu, M.D.

    June 2015




    Allergic Rhinitis: Common, Chronic and progressive genetic disease that can cause inflammation of the inside nose due to allergen.

    Symptoms: Occurs more than one hour most of the time and persist for more than weeks, months, and years.

    Sneezing, dripping, snorting, sniffing, and snoring

    Treatment: Manipulate the environment so allergy can be prevented 

    Complication: Affect quality of life

    n Nasal Swelling

    n Upper Respiratory infections

    n Otitis Media

    Sinusitis: obstruction of sinus opening due to swelling leading to stagnant of mucus and secondary bacterial infection

    n Sleep apnea: daytime fatigue and sleepiness

    n Asthma

    n Polyp formation


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      Asia Brewery Monthly Medical Forum

      Keeping updated with the latest knowledge in the medical and healthcare fields, Asia Brewery, Inc. Monthly Medical Forum provides the much-needed venue for lay people to understand and use knowledge towards better health.  

      Highly respected specialists who have been scholars under the sub-specialty program discuss relevant health issues with participants.  Over the last 16 years, topics of interest have covered practically every aspect of illnesses and healthcare.  Attendance is regularly full with an average of  300 participants monthly.

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    The Tan Yan Kee Foundation, Inc. is the corporate social responsibility arm of the Lucio Tan Group of Companies. For close to thirty years, TYKFI has been approaching corporate social responsibility from a holistic commitment framework targeting education, culture and sports; health and social welfare including environmental concerns; research; and manpower development.

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