scholarly journals Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges

2020 ◽  
pp. 375-381
Author(s):  
Ayesiga M. Herman ◽  
Alexander T. Hawkins ◽  
Kennedy Misso ◽  
Christian Issangya ◽  
Murad Tarmohamed ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Age Groups ◽  
Fold Increase ◽  
Tertiary Hospital ◽  
Late Presentation ◽  
High Morbidity ◽  
Emergency Presentation ◽  
Northern Tanzania ◽  
Clinical Records ◽  
Study Participants

PURPOSE A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital. METHODS Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed. RESULTS Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type. CONCLUSION High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.

scholarly journals Evaluation of outcomes in elderly patients diagnosed with colorectal cancer

2018 ◽  
Vol 5 (4) ◽  
pp. 1201
Author(s):  
Neil Lawrence ◽  
Joshua Griffiths ◽  
Keith Chapple
Keyword(s):  
Colorectal Cancer ◽  
Operative Treatment ◽  
Emergency Surgery ◽  
Performance Status ◽  
Significant Risk ◽  
Distant Metastases ◽  
The Elderly ◽  
High Morbidity ◽  
Tertiary Referral Centre ◽  
Emergency Presentation

Background: Colorectal cancer in the elderly carries a high morbidity and mortality. The National Bowel Cancer Audit Programme is a high-quality audit incorporating all UK colorectal cancer patients. Author analysed this database to investigate the local outcomes for this high-risk group.Methods: Data (mode of presentation, presence of metastatic disease, treatment surgery, colonic stent or conservative and WHO performance status) was collected on all patients aged 85 years or over diagnosed with colorectal cancer at a large tertiary referral centre over a 5-year period. Ninety day and 2 year-mortality was obtained for all patients.Results: Ninety patients (45 male, 45 female, median age 88.9 range 85.0-97.9 years) were included (47 emergency presentation, 43 elective presentation). A 18 of 47 patients underwent emergency surgery. A 90-day and 2-year mortality in this group was 17% and 69% respectively. 29 of 47 patients presenting as an emergency had non-operative treatment (2-year mortality 87%). Two years mortality for patients undergoing emergency surgery was 100% if aged above 90 years or if distant metastases were present. Eleven of 43 patients presenting electively underwent surgery. 90-day and 2-year mortality for this group was 18% and 0% respectively. Two years mortality for those presenting electively and undergoing non-operative treatment was 62%.Conclusions: Decision making must be very carefully considered in patients aged over 85 years as the presence of metastases, poor WHO performance status or age over 90 carries with it a significant risk of mortality at both 90 days and 2 years following diagnosis.

scholarly journals Identifying Age Cohorts Responsible for Peste Des Petits Ruminants Virus Transmission among Sheep, Goats, and Cattle in Northern Tanzania

Viruses ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 186 ◽  
Author(s):  
Catherine Herzog ◽  
William de Glanville ◽  
Brian Willett ◽  
Isabella Cattadori ◽  
Vivek Kapur ◽  
...  
Keyword(s):  
Age Groups ◽  
Virus Transmission ◽  
Transmission Risk ◽  
High Morbidity ◽  
Peste Des Petits Ruminants ◽  
Cross Sectional ◽  
Age Cohorts ◽  
Force Of Infection ◽  
Northern Tanzania ◽  
Pastoral Cattle

Peste des petits ruminants virus (PPRV) causes a contagious disease of high morbidity and mortality in global sheep and goat populations. To better control this disease and inform eradication strategies, an improved understanding of how PPRV transmission risk varies by age is needed. Our study used a piece-wise catalytic model to estimate the age-specific force of infection (FOI, per capita infection rate of susceptible hosts) among sheep, goats, and cattle from a cross-sectional serosurvey dataset collected in 2016 in Tanzania. Apparent seroprevalence increased with age, reaching 53.6%, 46.8%, and 11.6% (true seroprevalence: 52.7%, 52.8%, 39.2%) for sheep, goats, and cattle, respectively. Seroprevalence was significantly higher among pastoral animals than agropastoral animals across all ages, with pastoral sheep and goat seroprevalence approaching 70% and 80%, respectively, suggesting pastoral endemicity. The best fitting piece-wise catalytic models merged age groups: two for sheep, three for goats, and four for cattle. The signal of these age heterogeneities were weak, except for a significant FOI peak among 2.5–3.5-year-old pastoral cattle. The subtle age-specific heterogeneities identified in this study suggest that targeting control efforts by age may not be as effective as targeting by other risk factors, such as production system type. Further research should investigate how specific husbandry practices affect PPRV transmission.

scholarly journals Mucosa-associated Cultivable Aerobic Gut Bacterial Microbiota among Colorectal Cancer Patients Attending at the Referral Hospitals of Amhara Regional State, Ethiopia

2020 ◽  
Author(s):  
Yesuf Adem Siraj ◽  
Melese Gebeyehu Byadgelegn ◽  
Mensur Osman Yassin ◽  
Yohannes Zenebe Chekol
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Normal Tissue ◽  
Age Groups ◽  
Teaching Hospitals ◽  
Microbial Composition ◽  
Colorectal Cancer Resection ◽  
Bacterial Microbiota ◽  
Colorectal Cancer Patients ◽  
Study Participants

Abstract Background: Colorectal cancer (CRC) is one of the top ten causes of cancer deaths in the world. Despite an increased prevalence of colorectal cancer has been documented from developing countries, there is no any report regarding gut microbiota among colorectal cancer patients in Ethiopia. Therefore, the current study evaluated cultivable aerobic gut bacterial distributions among malignant and its adjacent normal biopsies of CRC patients.Methods: CRC patients who were under colorectal cancer resection surgery during April 2017 to February 2018 at Felege Hiwot Referral and University of Gondar Teaching Hospitals enrolled in the study. Biopsy specimens were taken from malignant and its adjacent normal-appearing tissues. Bacterial cultivation, quantification and characterization of saline washed biopsies were performed under aerobic and candle jar conditions. Differences in bacterial microbiota compositions between malignant and normal tissue biopsies were evaluated and analyzed using Microsoft excel 2010 and GraphPad Prism5 statistical software.Results: Fifteen CRC patients were participated with a mean age of 53.8 + 10.8 years old and majorities (73.3%) of patients were in between the age groups of 40 and 60 years old. The mean + SD bacterial microbiota of malignant biopsies (3.2x105 + 1.6x105 CFU/ml) was significantly fewer than that of adjacent normal tissue biopsies (4.0x105 + 2.2x105 CFU/ml). This dysbacteriosis is positively correlated with the occurrence of CRC (p=0.019). Proteobacteria (55.6%), Firmicutes (33.3%) and Fusobacteria (11.1%) were the most frequently isolated phyla from non-malignant biopsies while only Proteobacteria (58.8%) and Firmicutes (41.2%) from malignant ones. Family level differences were observed among phyla (Firmicutes and Proteobacteria) isolated from the study participants. For instance, the relative abundance of family Bacillaceae from malignant (26%) was lower than the normal biopsies (39%). On other hand, family Enterobacteriaceae was twice more abundant in malignant tissues (45%) than in its matched normal tissues (23%). Furthermore, the family Enterococcaceae (14%) of phylum Firmicutes was solely isolated from malignant tissue biopsies. Conclusion: The overall microbial composition of normal and malignant tissues was considerably different among the study participants. Further studies with culture independent analysis of mucosal microbiota will provide detail pictures of microbial composition and pathogenesis of CRC in Ethiopian settings.

scholarly journals Mucosa‐associated cultivable aerobic gut bacterial microbiota among colorectal cancer patients attending at the referral hospitals of Amhara Regional State, Ethiopia

Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Yesuf Adem Siraj ◽  
Melesse Gebeyehu Biadgelign ◽  
Mensur Osman Yassin ◽  
Yohannes Zenebe Chekol
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Normal Tissue ◽  
Age Groups ◽  
Teaching Hospitals ◽  
Microbial Composition ◽  
Colorectal Cancer Resection ◽  
Bacterial Microbiota ◽  
Colorectal Cancer Patients ◽  
Study Participants

Abstract Background Colorectal cancer (CRC) is one of the top ten causes of cancer deaths in the world. Despite an increased prevalence of colorectal cancer has been documented from developing countries, there is no any report regarding gut microbiota among colorectal cancer patients in Ethiopia. Therefore, the current study evaluated cultivable aerobic gut bacterial distributions among malignant and its adjacent normal biopsies of CRC patients. Methods CRC patients who were under colorectal cancer resection surgery during April 2017 to February 2018 at Felege Hiwot Referral and University of Gondar Teaching Hospitals enrolled in the study. Biopsy specimens were taken from malignant and its adjacent normal-appearing tissues. Bacterial cultivation, quantification and characterization of saline washed biopsies were performed under aerobic and candle jar conditions. Differences in bacterial microbiota compositions between malignant and normal tissue biopsies were evaluated and analyzed using Microsoft excel 2010 and GraphPad Prism5 statistical software. Results Fifteen CRC patients were participated with a mean age of 53.8 ± 10.8 years old and majorities (73.3 %) of patients were in between the age groups of 40 and 60 years old. The mean ± SD bacterial microbiota of malignant biopsies (3.2 × 105 ± 1.6 × 105 CFU/ml) was significantly fewer than that of adjacent normal tissue biopsies (4.0 × 105 ± 2.2 × 105 CFU/ml). This dysbacteriosis is positively correlated with the occurrence of CRC (p = 0.019). Proteobacteria (55.6 %), Firmicutes (33.3 %) and Fusobacteria (11.1 %) were the most frequently isolated phyla from non-malignant biopsies while only Proteobacteria (58.8 %) and Firmicutes (41.2 %) were from malignant ones. Family level differences were observed among phyla (Firmicutes and Proteobacteria) isolated from the study participants. For instance, the relative abundance of family Bacillaceae from malignant (26 %) was lower than the normal biopsies (39 %). On other hand, family Enterobacteriaceae was twice more abundant in malignant tissues (45 %) than in its matched normal tissues (23 %). Furthermore, the family Enterococcaceae (14 %) of phylum Firmicutes was solely isolated from malignant tissue biopsies. Conclusions The overall microbial composition of normal and malignant tissues was considerably different among the study participants. Further culture independent analysis of mucosal microbiota will provide detail pictures of microbial composition differences and pathogenesis of CRC in Ethiopian settings.

A Psychosocial Assessment of Patients Receiving Orthopaedic Treatment in a Tertiary Hospital in Northern Tanzania

2018 ◽  
Author(s):  
Joy Obayemi ◽  
Elizabeth Card ◽  
Octavian Shirima ◽  
Honest Massawe ◽  
Faiton Mandari ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Psychosocial Assessment ◽  
Orthopaedic Treatment ◽  
Northern Tanzania

scholarly journals Accuracy of Finnish Cancer Registry colorectal cancer data: a comparison between registry data and clinical records

2021 ◽  
pp. 1-5
Author(s):  
Pipsa Lunkka ◽  
Nea Malila ◽  
Heidi Ryynänen ◽  
Sanna Heikkinen ◽  
Ville Sallinen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Registry ◽  
Registry Data ◽  
Cancer Data ◽  
Clinical Records

scholarly journals The discovery of biological subphenotypes in ARDS: a novel approach to targeted medicine?

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Karin Wildi ◽  
Samantha Livingstone ◽  
Chiara Palmieri ◽  
Gianluigi LiBassi ◽  
Jacky Suen ◽  
...  
Keyword(s):  
Age Groups ◽  
Geographical Location ◽  
High Morbidity ◽  
Shock State ◽  
Pharmacological Agents ◽  
New Approach ◽  
Novel Approach ◽  
Active Research ◽  
Targeted Medicine ◽  
Core Features

AbstractThe acute respiratory distress syndrome (ARDS) is a severe lung disorder with a high morbidity and mortality which affects all age groups. Despite active research with intense, ongoing attempts in developing pharmacological agents to treat ARDS, its mortality rate remains unaltered high and treatment is still only supportive. Over the years, there have been many attempts to identify meaningful subgroups likely to react differently to treatment among the heterogenous ARDS population, most of them unsuccessful. Only recently, analysis of large ARDS cohorts from randomized controlled trials have identified the presence of distinct biological subphenotypes among ARDS patients: a hypoinflammatory (or uninflamed; named P1) and a hyperinflammatory (or reactive; named P2) subphenotype have been proposed and corroborated with existing retrospective data. The hyperinflammatory subphenotyope was clearly associated with shock state, metabolic acidosis, and worse clinical outcomes. Core features of the respective subphenotypes were identified consistently in all assessed cohorts, independently of the studied population, the geographical location, the study design, or the analysis method. Additionally and clinically even more relevant treatment efficacies, as assessed retrospectively, appeared to be highly dependent on the respective subphenotype. This discovery launches a promising new approach to targeted medicine in ARDS. Even though it is now widely accepted that each ARDS subphenotype has distinct functional, biological, and mechanistic differences, there are crucial gaps in our knowledge, hindering the translation to bedside application. First of all, the underlying driving biological factors are still largely unknown, and secondly, there is currently no option for fast and easy identification of ARDS subphenotypes. This narrative review aims to summarize the evidence in biological subphenotyping in ARDS and tries to point out the current issues that will need addressing before translation of biological subohenotypes into clinical practice will be possible.

Zip Code-Related Income Disparities in Patients with Colorectal Cancer

2021 ◽  
pp. 000313482110234
Author(s):  
Yasmeen Z. Qwaider ◽  
Naomi M. Sell ◽  
Chloe Boudreau ◽  
Caitlin E. Stafford ◽  
Rocco Ricciardi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Income Group ◽  
Tertiary Hospital ◽  
Lower Proportion ◽  
Stage Iii ◽  
Median Income ◽  
Lower Income ◽  
Income Disparities ◽  
The Mean ◽  
Zip Code

Introduction Screening and early detection reduce morbidity and mortality in colorectal cancer. Our aim is to study the effect of income disparities on the clinical characteristics of patients with colorectal cancer in Massachusetts. Methods Patients were extracted from a database containing all surgically treated colorectal cancers between 2004 and 2015 at a tertiary hospital in Massachusetts. We split patients into 2 groups: “above-median income” and “below-median income” according to the median income of Massachusetts ($74,167). Results The analysis included 817 patients. The above-median income group consisted of 528 patients (65%) and the below-median income group consisted of 289 patients (35%). The mean age of presentation was 64 ± 15 years for the above-median income group and 67 ± 15 years for the below-median income group ( P = .04). Patients with below-median income were screened less often ( P < .001) and presented more frequently with metastatic disease ( P = .02). Patients with above-median income survived an estimated 15 months longer than those with below-median income ( P < .001). The survival distribution was statistically significantly different between the groups for stage III disease ( P = .004), but not stages I, II, or IV ( P = 1, 1, and .2, respectively). For stage III disease, a lower proportion of below-median income patients received chemotherapy (61% vs. 79%, P = .002) and a higher proportion underwent nonelective surgery (5% vs. 2%, P = .007). Conclusions In Massachusetts, patients with colorectal cancer residing in lower income areas are screened less, received adjuvant chemotherapy less, and have worse outcomes, especially when analyzing those who present with stage III disease.

scholarly journals 273 The Consequences of a Failed Screening Programme

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Sharrock ◽  
C Whelton ◽  
R Paton
Keyword(s):  
Screening Programme ◽  
Demographic Data ◽  
Late Presentation ◽  
Developmental Dysplasia ◽  
Late Diagnosis ◽  
Operation Rate ◽  
Increasing Trend ◽  
The Uk ◽  
Clinical Records ◽  
Surgical Treatments

Abstract Introduction Controversy exists surrounding the efficacy of the UK screening programme for developmental dysplasia of the hip (DDH). Method Clinical records were reviewed in children who were treated surgically for DDH. Demographic data, age and mode of presentation, and surgical treatments were analysed, as well as outcomes, re-operation rate and AVN incidence. Late diagnosis was defined as greater than 4 months. Results 106 children (16 male, 90 female) underwent surgery from 1997 to 2018. 95 hips were operated for dislocation and 22 were operated for dysplasia. 13 patients had bilateral dislocations. Of the dislocated hips, the median age at diagnosis was 9 months (IQR 2-19). 56% were diagnosed late. In the late diagnosis group the median age for diagnosis was 19 months (IQR 15-21). We have identified an increasing trend in late presentation in recent years. This has been matched with an increasing trend in operation rates for dislocation per 1000 births. Conclusions This study demonstrates that DDH is being diagnosed increasingly late, which correlates with an increased need for surgical management. This suggests that the current UK screening programme is failing to identify children with DDH in a timely fashion, which necessitates more aggressive surgical treatment and less favourable outcomes.

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