scholarly journals Is the incidence of colorectal cancer increasing in the younger population? - a UK DGH experience

2020 ◽  
Vol 8 (1) ◽  
pp. 186
Author(s):  
Shirish Tewari ◽  
Vinay Shah ◽  
Paul Cathcart ◽  
Vivek Gupta ◽  
Nick Reay-Jones
Keyword(s):  
Colorectal Cancer ◽  
Sample Size ◽  
Age Distribution ◽  
Young Patients ◽  
Colorectal Cancers ◽  
Team Meetings ◽  
Younger Age ◽  
Age Range ◽  
Multidisciplinary Team Meetings ◽  
Larger Sample

Background: Over the past few years we have noticed increasing number of young patients diagnosed with colorectal cancer being discussed in colorectal multidisciplinary team meetings. Our aim was to look if the incidence is in fact rising in the younger age-group patients, aged below 40 years.  Methods: Retrospective data was collected from the Info flex database system at our DGH for all colorectal cancers diagnosed between January 2014-December 2019. The incidence of colorectal cancers under the age of 40 years was calculated as well as other demographics parameters were taken into consideration.Results: Total 770 colorectal cancers were diagnosed during the study period. 451 (58.58% were male and 319 (41.42%) were female. The age range was 25-98 years. 2.06%, 3.19%, 1.14%, 0%, 2.22%, 2.38% patients below the age of 40 years were diagnosed with colorectal cancer in 2014, 2015, 2016, 2017, 2018 and 2019 respectively.Conclusions: Our study does not show any increasing trend in the incidence of colorectal cancer in the younger population. One of the limitations of this study is the limited sample size used. A larger sample size or analysis of colorectal registries could be more informative to ascertain if there is a change in the age-distribution pattern of colorectal cancers.  

scholarly journals PLASMAPHERESIS;

2017 ◽  
Vol 24 (06) ◽  
pp. 855-858
Author(s):  
Hamida Qureshi ◽  
Hamzullah Khan
Keyword(s):  
Myasthenia Gravis ◽  
Young Patients ◽  
Blood Bank ◽  
Therapeutic Procedure ◽  
Thrombocytopenic Purpura ◽  
Younger Age ◽  
Study Results ◽  
The Subject ◽  
Age Range ◽  
Study Setting

Objectives: To determine the frequency of major indications requireplasmapheresis in blood bank of Lady Reading Hospital Peshawar. Study Design: Crosssectional study. Setting: Blood bank of Lady Reading Hospital Peshawar. Period: June 2010to June 2012. Material and methods: Relevant information’s were recorded on a pre-designedquestionnaire prepared in accordance with the objectives of the study. Results: A total of 54patients were enrolled in the trial. 23 (42.59%) were females, and 31(57.41%) were males. Malesto females ration was 1.4:1. We received patients for plasmaphersis in age ranging from 15 to74 years. Majority were young patients in age range 15 to 34 years age. We received majorityof the patients for the subject procedure from ICU (Intensive care unit) 20(73%), followed bycardiothoracic unit 17(31.48%). We also receive two volunteers during study. The frequencyof various indications for plasmapheresis were; myasthenia gravis 29(53.7%), Guillen barresyndrome 20(37.04%) and thrombocytopenic purpura 3(5.56%). Conclusion. From thisstudy we concluded that that autoimmune diseases are common in younger age which is avery serious concern for our society. Plasmapheresis is a therapeutic procedure as well andpatients with autoimmune disorders get relieved with it symptomatically as autoimmuneantibodies are removed. Myasthenia gravis was counted as major disease followed by GBSand thrombocytopenic purpura in our population.

scholarly journals Optimization of transmural care by implementation of an online expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases: A prospective analysis

2020 ◽  
pp. 1357633X2095713
Author(s):  
Tessa Hellingman ◽  
Merijn E de Swart ◽  
Martijn R Meijerink ◽  
Wilhelmina H Schreurs ◽  
Barbara M Zonderhuis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Improvement ◽  
Liver Metastases ◽  
Multidisciplinary Team ◽  
Treatment Strategy ◽  
Expert Panel ◽  
Local Treatment ◽  
Colorectal Cancer Liver Metastases ◽  
Team Meetings ◽  
Multidisciplinary Team Meetings

Introduction Centralization of oncological care results in a growing demand for specialized consultations and referrals. Improved telemedicine solutions are needed to facilitate access to specialist care and select patients eligible for referral. The purpose of this quality improvement initiative was to optimize transmural care for patients suffering from colorectal cancer liver metastases through implementation of an online expert panel. Methods A digital communication platform was developed to share medical data, including high-quality diagnostic imaging of patients suffering from colorectal cancer liver metastases. Feasibility of local treatment strategies was assessed by a panel of liver specialists to select patients for referral. After implementation, an observational cohort study was conducted to evaluate quality improvement in transmural care using revised Standards for Quality Improvement Reporting Excellence guidelines. Results From September 2016–September 2018, eight hospitals were connected to the platform, covering a population of 3 m. In total, 123 cases were assessed, of which 54 (43.9%) were prevented from needless physical referral. Assessment of treatment strategy by an online expert panel significantly reduced the average lead time during multidisciplinary team meetings from 3.73 min to 2.12 min per patient ( p < 0.01). Conclusions Implementation of an online expert panel is an innovative, accessible and user-friendly way to provide cancer-specific expertise to regional hospitals. E-consultation of such panels may result in more efficient multidisciplinary team meetings and prevent fragile patients from needless referral. Sustainability of these panels however is subject to structural financial compensation, so a cost-effectiveness analysis is warranted.

scholarly journals Thalassemia and COVID-19: Susceptibility and Severity

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Somayeh Rahimi ◽  
Saba Zakeri ◽  
Mahsa Nouri ◽  
Yaser Mohassel ◽  
Bahareh Karami ◽  
...  
Keyword(s):  
Sample Size ◽  
Observational Studies ◽  
Web Of Science ◽  
Case Reports ◽  
Young Patients ◽  
Iron Chelation ◽  
Hemoglobin F ◽  
Adrenal Hypofunction ◽  
Key Terms ◽  
Larger Sample

Context: COVID-19 results in an imbalance between procoagulant and anticoagulant homeostatic mechanisms that could be complicated with thrombotic events. In β-thalassemia patients, the presence of comorbidities, iron overload, adrenal hypofunction, splenectomy, and chronic hypercoagulable state might increase the susceptibility to COVID-19 and its severity. Evidence Acquisition: The search was conducted in PubMed, Web of Science, and Scopus databases for the key terms of β-thalassemia/thalassemia and COVID-19 until July 2021. Results: The survey of published observational studies (mostly multicenter and case reports) indicated a lower prevalence of COVID-19 in β-thalassemia patients compared with the general population, as well as mild to moderate COVID-19 in these patients, especially in those without comorbidity. β-Thalassemia children were susceptible to COVID-19 but with less severity compared to adults. There is no report of pulmonary embolism and thrombotic events in β-thalassemia patients with COVID-19; however, coagulation abnormality and pulmonary microembolism have been found in these patients. Conclusions: Findings could be interpreted by the presence of high hemoglobin F (HbF) levels, the advantage of hydroxyurea (HU) therapy, splenectomy, and iron chelation therapy in these patients. However, due to the low sample size and studying mainly young patients, the results should be interpreted with caution, and it still needs more studies with a larger sample size to confirm these findings.

Planning the Size of Clinical Trials with Allowance for Patient Noncompliance

1990 ◽  
Vol 29 (03) ◽  
pp. 243-246 ◽  
Author(s):  
M. A. A. Moussa
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Sample Size ◽  
Event Rate ◽  
Survival Functions ◽  
Time Intervals ◽  
Patient Noncompliance ◽  
Event Rates ◽  
Larger Sample

AbstractVarious approaches are considered for adjustment of clinical trial size for patient noncompliance. Such approaches either model the effect of noncompliance through comparison of two survival distributions or two simple proportions. Models that allow for variation of noncompliance and event rates between time intervals are also considered. The approach that models the noncompliance adjustment on the basis of survival functions is conservative and hence requires larger sample size. The model to be selected for noncompliance adjustment depends upon available estimates of noncompliance and event rate patterns.

Comparison of Co-Presence of Epstein-Barr Virus and High-Risk Human Papillomaviruses in Colorectal Cancers in the Middle East Region

2020 ◽  
Author(s):  
Karim Nagi ◽  
Ishita Gupta ◽  
Hamda A Al-Thawadi ◽  
Ayesha Jabeen ◽  
Mohammed I. Malk ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Epstein Barr Virus ◽  
Human Papillomaviruses ◽  
Colorectal Cancers ◽  
Barr Virus ◽  
Human Carcinomas ◽  
Epstein Barr ◽  
Invasive Carcinomas ◽  
High Risk Hpv

Background: Several studies have shown the presence of onco viral DNA in colorectal tumor tissues. Viral infection by onco-viruses such as Human papillomaviruses (HPVs) and Epstein–Barr virus (EBV) are well-known to be involved in the onset and/or progression of numerous human carcinomas. Methods: We explored the co-presence of high-risk HPVs and EBV in a cohort of colorectal cancer samples from Lebanon (94) and Syria (102) by PCR, immunohistochemistry and tissue microarray. Results: The results of the study point out that 54% of colorectal cancer cases in Syria are positive for high-risk HPVs, while 30% of the cases in Lebanon are positive for these viruses; the most frequent high-risk HPV types in these populations are 16, 18, 31, 33 and 35. Analysis of LMP1 showed similar results in both populations; 36% of Syrian and 31% of Lebanese samples. Additionally, we report that EBV and high-risk HPVs are co-present in these samples. In Syrian samples, EBV and HPVs are co-present in 16% of the population, however, in the Lebanese samples, 20% of the cases are positive for both EBV and HPVs; their co-presence is associated with high/intermediate grade invasive carcinomas. Conclusion: These data suggest that EBV and high-risk HPVs are co-present in human colorectal cancers where they can cooperate in the progression of these cancers. Nevertheless, further studies are needed to elucidate the role of those oncoviruses in the development of human colorectal carcinomas.

Augmentation Strategies for Clozapine-Resistant Patients with Schizophrenia

2020 ◽  
Vol 26 (2) ◽  
pp. 218-227
Author(s):  
Yi-Hang Chiu ◽  
Chia-Yueh Hsu ◽  
Mong-Liang Lu ◽  
Chun-Hsin Chen
Keyword(s):  
Sample Size ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Mood Stabilizers ◽  
Treatment Resistant ◽  
Double Blind ◽  
Beneficial Effects ◽  
Augmentation Strategies ◽  
Pubmed Database ◽  
Augmentation Strategy ◽  
Larger Sample

Background: Clozapine has been used in treatment-resistant patients with schizophrenia. However, only 40% of patients with treatment-resistant schizophrenia have response to clozapine. Many augmentation strategies have been proposed to treat those clozapine-resistant patients, but the results are inconclusive. In this review, we intended to review papers dealing with the augmentation strategies in the treatment of clozapineresistant patients with schizophrenia. Method: We reviewed randomized, double-blind, placebo- or sham-controlled trials (RCT) for clozapine-resistant patients with schizophrenia in Embase, PsycINFO, Cochrane, and PubMed database from January 1990 to June 2019. Results: Antipsychotics, antidepressants, mood stabilizers, brain stimulation, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation, and other strategies, were used as an augmentation in clozapine-resistant patients with schizophrenia. Except for better evidence in memantine with 2 RCTs and cognitive behavior therapy in 2 studies to support its effectiveness, we found that all the other effective augmentations, including sulpiride, ziprasidone, duloxetine, mirtazapine, ECT, sodium benzoate, ginkgo biloba, and minocycline, had only one RCT with limited sample size. Conclusion: In this review, no definite effective augmentation strategy was found for clozapine-resistant patients. Some potential strategies with beneficial effects on psychopathology need further studies with a larger sample size to support their efficacy.

PI3K/ Akt/ mTOR Pathway as a Therapeutic Target for Colorectal Cancer: A Review of Preclinical and Clinical Evidence

2019 ◽  
Vol 20 (12) ◽  
pp. 1217-1226 ◽  
Author(s):  
Arunaksharan Narayanankutty
Keyword(s):  
Colorectal Cancer ◽  
Drug Resistance ◽  
Therapeutic Target ◽  
Clinical Evidence ◽  
Mtor Pathway ◽  
Colorectal Cancers ◽  
Patent Literature ◽  
Mtor Signalling ◽  
Natural And Synthetic

Background: Phosphoinositide 3-kinase (PI3Ks) is a member of intracellular lipid kinases and involved in the regulation of cellular proliferation, differentiation and survival. Overexpression of the PI3K/Akt/mTOR signalling has been reported in various forms of cancers, especially in colorectal cancers (CRC). Due to their significant roles in the initiation and progression events of colorectal cancer, they are recognized as a striking therapeutic target. Objective: The present review is aimed to provide a detailed outline on the role of PI3K/Akt/mTOR pathway in the initiation and progression events of colorectal cancers as well as its function in drug resistance. Further, the role of PI3K/Akt/mTOR inhibitors alone and in combination with other chemotherapeutic drugs, in alleviating colorectal cancer is also discussed. The review contains preclinical and clinical evidence as well as patent literature of the pathway inhibitors which are natural and synthetic in origin. Methods: The data were obtained from PubMed/Medline databases, Scopus and Google patent literature. Results: PI3K/Akt/mTOR signalling is an important event in colorectal carcinogenesis. In addition, it plays significant roles in acquiring drug resistance as well as metastatic initiation events of CRCs. Several small molecules of natural and synthetic origin have been found to be potent inhibitors of CRCs by effectively downregulating the pathway. Data from various clinical studies also support these pathway inhibitors and several among them are patented. Conclusion: Inhibitors of the PI3K/mTOR pathway have been successful for the treatment of primary and metastatic colorectal cancers, rendering the pathway as a promising clinical cancer therapeutic target.

scholarly journals ‘Statistical Irreproducibility’ Does Not Improve with Larger Sample Size: How to Quantify and Address Disease Data Multimodality in Human and Animal Research

2021 ◽  
Vol 11 (3) ◽  
pp. 234
Author(s):  
Abigail R. Basson ◽  
Fabio Cominelli ◽  
Alexander Rodriguez-Palacios
Keyword(s):  
Sample Size ◽  
Data Visualization ◽  
Random Sampling ◽  
Intestinal Inflammation ◽  
Random Number Generation ◽  
Outcome Data ◽  
Multimodal Distributions ◽  
Disease Subtypes ◽  
Study Designs ◽  
Larger Sample

Poor study reproducibility is a concern in translational research. As a solution, it is recommended to increase sample size (N), i.e., add more subjects to experiments. The goal of this study was to examine/visualize data multimodality (data with >1 data peak/mode) as cause of study irreproducibility. To emulate the repetition of studies and random sampling of study subjects, we first used various simulation methods of random number generation based on preclinical published disease outcome data from human gut microbiota-transplantation rodent studies (e.g., intestinal inflammation and univariate/continuous). We first used unimodal distributions (one-mode, Gaussian, and binomial) to generate random numbers. We showed that increasing N does not reproducibly identify statistical differences when group comparisons are repeatedly simulated. We then used multimodal distributions (>1-modes and Markov chain Monte Carlo methods of random sampling) to simulate similar multimodal datasets A and B (t-test-p = 0.95; N = 100,000), and confirmed that increasing N does not improve the ‘reproducibility of statistical results or direction of the effects’. Data visualization with violin plots of categorical random data simulations with five-integer categories/five-groups illustrated how multimodality leads to irreproducibility. Re-analysis of data from a human clinical trial that used maltodextrin as dietary placebo illustrated multimodal responses between human groups, and after placebo consumption. In conclusion, increasing N does not necessarily ensure reproducible statistical findings across repeated simulations due to randomness and multimodality. Herein, we clarify how to quantify, visualize and address disease data multimodality in research. Data visualization could facilitate study designs focused on disease subtypes/modes to help understand person–person differences and personalized medicine.

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