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Bone metastasis from endometrial cancer is rare. Most of the early stage endometrial cancers with endometrioid histology are confined to the uterus at the time of diagnosis and confer a good prognosis. Endometrial metastases to the bone are generally restricted to the axial skeleton, including the pelvis and thoracolumbar vertebrae. Skeletal metastases in the appendicular skeleton such as scapula, clavicle and extremities to tibia, and tarsus are rarely reported. We present the case of a 50-year-old woman with diagnosis of endometrioid adenocarcinoma of the endometrium, FIGO stage IB, grade 2, with lympho-vascular space invasion who developed recurrence within 10 months with bone metastasis to left scapula and extraosseous soft tissue mass over left shoulder. There are very few cases reported in literature of scapular metastases in an early-stage endometrial carcinoma. We discuss evaluation, treatment options, overall survival rates and provide a literature review of prior published reports.

The central tenet in PCOS is predicting the development of the development of metabolic syndrome is Insulin resistance (IR). Adipocytokines are hormones produced by adipose cells that help to regulate insulin secretion and resistance in the body. This study discusses the effect of different adipocytokines and their patterns (increased or reduced) in predicting insulin resistance in obese and lean PCOS patients. A systematic review and meta-analysis were performed which identified relevant studiesfrom 2010 to 2020. Data was analyzed using Review Manager Version (RevMan) 5.4 software. A fixed-effect model was fitted to estimate the pooled effect of adipocytokines. I2 test statistics were done to test the heterogeneity of included studies. Of 17 selected studies with 1504 participants, there is considerably lower levels of adiponectin among women with PCOS as compared with healthy controls with mean difference of −3.79 (95% CI = 3.97–3.60, I² = 73%; P = 0.005). In comparison to their healthy counterparts, leptin levels were shown to be higher in women with PCOS with mean difference of 3.64 (95% CI = 3.20–4.08, I² = 97%; P = 0.00001). Leptin concentration was shown to be directly related to IR and BMI. After controlling for BMI and age-related effects, adiponectin levels appear to be lower in women with PCOS compared to non-PCOS controls but leptin levels appear to be higher. In conclusion, increased in adipocytokines such as leptin, visfatin and chemerin predict IR among both obese and lean PCOS whereas decreased levels of zinc-alpha2 glycoprotein predict IR. Adipocytokines can be potential predictive serum biomarkers of insulin resistance (IR) in PCOS. [ABSTRACT FROM AUTHOR]

As a small group of academicians in a private medical university in Malaysia, we observed, in 2020, how the COVID-19 pandemic, changed our lives and the lives of our students. We would like to share our experiences in this commentary. It describes the contingency plans taken by the School of Medicine at International Medical University (IMU) to ensure that the delivery of the medical curriculum and its assessments has the best possible outcome in these tumultuous times, with plans to improve the delivery of teaching and learning, with an emphasis on technology-enhanced learning (TEL). We hope that this commentary is beneficial to those reading and that the contingency plans developed by IMU will help other institutions in the country and in this region navigate safely through the COVID-19 storm. [ABSTRACT FROM AUTHOR]

Extragastrointestinal tumour of rectovaginal septum (rvGIST) is a rare malignancy that affects rectovaginal septum. We present a case of rvGIST that was initially managed as cervical eGIST based on clinical assessment. A 66-yearold woman presented with postmenopausal bleeding and constipation. Bimanual pelvic examination revealed an irregular mass occupying the vagina. CT thorax, abdomen and pelvis showed a 9.2 x 10.0 x 14.0 cm pelvic mass arising from cervix, extending superiorly to involve the uterus. The patient proceeded to undergo total abdominal hysterectomy, bilateral salpingo-oophorectomy, enucleation of rectovaginal septum mass, rectosigmoidectomy and permanent colostomy. Intraoperatively, there was a 9 x 7 cm mass arising from rectovaginal septum. Histopathological examination of surgical specimen revealed spindle cell tumour diffusely positive for CD34, CD117 and DOG1. The final diagnosis was rvGIST. In conclusion, the diagnosis of rvGIST require a combination of clinical assessment with intraoperative finding and histological assessment of the surgical specimen. [ABSTRACT FROM AUTHOR]

Medical education in Malaysia is facing challenges related to the increasing number of local private and foreign medical universities. The key issue is whether the system is producing doctors who have adequate competencies for fundamental patient-centred care. The Malaysian Medical Licensing Examination (MMLE) was proposed by the Ministry of Health (MOH) as a common licensing examination for which all graduates must sit prior to obtaining registration to practice. Currently, this exam is only taken by Malaysian students graduating from foreign medical colleges. However, the local Malaysian universities, both public and private, have different curricula for preparing undergraduates for future housemanships. The question is whether the educational programs of these universities are robust enough in delivering curricula that produce safe and competent doctors. Moving forward, it must be determined whether there is a need for extending the Malaysian Medical Licensing Examination (MMLE) to all graduates of both local and foreign medical universities, thereby creating a marker of excellence by which to measure Malaysian education and practice. [ABSTRACT FROM AUTHOR]

Workplace learning is essentially informal that is unstructured, unintended and opportunistic from educational view point. Recall of factual knowledge and applying skills is central in workplace so learning becomes meaningful and evidence based. To maximise their learning, the learners must take active participation in their own learning, set goals and march towards achieving these goals. The objective of the teacher at this juncture is obliging to the needs of the learners and of the patients. This review aims to address the teaching and learning theories that impact the workplace learning, factors influencing workplace based learning, identifying opportunities for learning to occur parallel with work and strategies that maximise successful workplace learning. [ABSTRACT FROM AUTHOR]

Introduction: Self-assessment is a mechanism to evaluate one's own performance and identify strengths and weaknesses. However, there is paucity of information on the the validity of self-assessment in the literature. This study is planned to assess the validity of medical students' self-assessment skills in clinical examinations with long case during their postings in Obstetrics and Gynaecology. Methods: A cross sectional study was conducted during Obstetrics and Gynaecology (O&G) rotation assessing the students performance in the clinical long case examination. Participants were 80 fourth year medical students who were in their last week of their O&G rotation between August and December 2019. Each student was given a random case from the obstetric ward for the clinical long case examination during their final week of posting. At the end of examination, both student and examiner were tasked to independently evaluate the performance with a standardized grading sheet. Students were assessed in three areas namely Case Presentation (4 items), Case Discussion (4 items) and Professionalism and Overall approach to the practice of medicine (2 items). Results: The correlation coefficient was identified to be 0.307, p<0.01, indicating validity in self-assessment in the context of a clinical examination. The overall bias index was -0.97. Students underrated themselves in all areas with bias indexes of -0.35 in case presentation, -0.26 for case discussion and -0.35 in the professionalism and overall approach to practice. The correlation coefficients were 0.186, 0.360 and 0.170 respectively, indicating that in isolation only the component of case discussion showed significant correlation (p<0.01). Conclusion: Self-assessment in clinical examination is shown to be a valid assessment method when multiple assessment items are combined. [ABSTRACT FROM AUTHOR]

We performed a systematic review to identify the role of microRNAs (miRNAs) as biomarkers in the progression of cervical precancerous lesions. A comprehensive search of the Cochrane Controlled Register of Trials, PubMed, ScienceDirect, and Embase databases was performed for articles published between January 2010 and June 2020. The following Medical Subject Headings (MeSH) terms were searched: "microRNA" and "cervical" and "lesion." All study designs that aimed to evaluate the correlation of miRNA expression with different precancerous cervical staging and/or cervical cancer were included, except for case reports and case series. Approximately 82 individual miRNAs were found to be significant in differentiating the stages of cervical carcinogenesis. Among the miRNAs, miR-21 is the most prevalent, and it is consistently upregulated progressively from normal cervical to worsening cervical lesion stages in both cell and serum samples. miR-205 has been shown to have a higher specificity than human papilloma virus testing in predicting the absence of high-grade squamous intraepithelial lesions (HSILs) in exfoliated cell samples. The tumor suppressor miRNAs miR-34, let-7, miR-203 miR-29, and miR-375 were significantly downregulated in low-grade squamous intraepithelial lesions, HSILs, and cervical cancer. We found significant dysregulated miRNAs in cervical carcinogenesis with their dynamic expression changes and ability to detect viral persistency, risk prediction of low-grade lesions (cervical intraepithelial neoplasia [CIN] 2) to high-grade lesions (CIN 3), and progression of CIN 3 to cancer. Their ability to discriminate HSILs from non-dysplastic lesions has potential implications in early diagnosis and reducing overtreatment of otherwise regressive early preinvasive lesions.