Clinical profile of 1208 newly diagnosed colorectal cancer patients in Tamil Nadu-A multi-centric survey

BACKGROUND

An increasing incidence of colorectal cancer (CRC) is being reported in developing countries, including India. Most Indian studies on CRC are retrospective and single-centered. The present study is an attempt to understand the current clinical profile and stage of newly diagnosed CRCs across multiple centers in Tamil Nadu, India.

METHODS

A multi-centric observational survey was conducted between September 1, 2021, and August 31, 2022, under the aegis of the Indian Society of Gastroenterology - Tamil Nadu chapter. Patients 18 years of age and older with a recent diagnosis of CRC fulfilling the inclusion criteria were prospectively recruited at the participating centers. Their demographic, clinical, biochemical, endoscopic, histopathologic, radiologic and risk factor details were systematically collected and analyzed.

RESULTS

Across 23 centers in Tamil Nadu, 1208 patients were recruited. The male:female ratio was 1.49:1, while mean (SD) age was 57.7 (13.5) years. A majority (81.9%) were Tamils and 78.5% belonged to lower socioeconomic classes. The predominant symptoms were hematochezia (30.2%) and a change in bowel habits (27.5%). The most common locations were the rectum (34.3%) and rectosigmoid (15.1%). Synchronous CRCs were seen in 3.3% and synchronous colorectal polyps in 12.8%. Predisposing factors for CRC were seen in 2%. A past history of any cancer among CRC patients was obtained in 3.1% and a family history of any cancer was found in 7.6%. Patients who were either overweight or obese constituted 46.4% of the study population. At presentation, the predominant stages were stage III (44.7%) and stage IV (20.8%).

CONCLUSIONS

A majority of patients with newly diagnosed CRC in Tamil Nadu belonged to the lower socioeconomic classes. About 60% had CRCs located within the reach of the flexible sigmoidoscope. Two-thirds of the patients exceeded stage II disease at presentation.

TRIAL REGISTRATION

Not applicable.

Molecular docking study on vitamin D supplements to understand their interaction with VDR-RXRα heterodimer and VDRE of TAGAP gene

The expression level of T cell activation Rho GTPase activating protein (TAGAP) gene is higher in rheumatoid arthritis (RA) patients compared to healthy individuals. Vitamin D receptor element (VDRE) sequences present in the regulatory region of TAGAP gene are targeted by vitamin D dependent Vitamin D receptor (VDR) - retinoic acid X receptor (RXR) heterodimer complex to regulate the TAGAP gene expression. Reduction in the expression of the TAGAP gene can prevent different severity of RA disease conditions. Calcitriol is a proven vitamin D supplement prescribed to patients with RA. However, it is involved in causing hypercalcemia. Maxacalcitol, an analog of vitamin D, is shown to have less hypercalcemic activity when compared to calcitriol. This study was done to analyze and compare the binding modes of calcitriol and maxacalcitol with VDR. We also studied the interactions of these compounds with the VDR-RXRα heterodimer complex. In addition, the binding of the ligand-activated heterodimer complexes with VDREs of the TAGAP gene was also analyzed to comprehend the binding affinities of calcitriol and maxacalcitol to the gene. The current work utilizes in silico molecular docking and simulation analysis to understand the mechanism in each complex formation.Communicated by Ramaswamy H. Sarma.

An Unusual Case of Rectal Bleed in an Section Adolescent: Solitary Rectal Ulcer Syndrome Mimicking Rectosigmoid Malignancy

Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon rectal disorder. Severe rectal bleeding, anaemia and a mass on evaluation are a rare presentation of SRUS, and can pose as an endoscopic challenge in differentiating from other causes of rectal bleeding. The incidence of SRUS is 1 in 100,000 people per year. Hence, a high degree of suspicion and timely diagnosis is necessary. The present case case is about a 17-year-old female who presented with rectal bleeding. Physical evaluation revealed a large polypoidal rectal mass mimicking malignancy which later turned out to be SRUS. The patient improved with medical management. On outpatient follow-up, she had no complaints after a month and follow-up lower endoscopy and imaging later revealed complete healing within three months. Although uncommon, SRUS should be considered as a potential cause of lower gastrointestinal bleeding after sinister causes have been ruled out.

Size Dependent Uptake and Hemolytic Effect of Zinc Oxide Nanoparticles on Erythrocytes and Biomedical Potential of ZnO-Ferulic acid Conjugates

Despite zinc oxide nanoparticles (ZnONPs) being increasingly used as carriers in biomedical fields due to their multifaceted properties and therapeutic importance, better understanding of the mechanisms and cellular consequences resulting from their interaction with cells and cellular components has been warranted. In the present study, we investigate the size-dependent interaction of ZnONPs on RBCs, and its impact on cell viability, DNA damage, ROS generation and morphological changes, employing cellular and analytical methods. Size, charge, stability and solubility were confirmed by DLS, zeta potential, ICP-AES and TEM analysis. Further ICP-AES, TEM, spectroscopic observations and cell based assays showed that ZnONPs exhibited a size dependent impact on RBCs and haemoglobin (Hb), particularly size <50 nm. Conversely, ferulic acid (FA) conjugates and serum albumin significantly reduced the adverse effects exhibited by ZnONPs. The extent of DNA damage and ROS generation is comparatively low in ZnONPs-FA than in ZnONPs alone treated cells. Thus our study documents a novel conceptualization delineating the influence of size on the material properties and therapeutic potential of nanoparticle.

Protective effect of saffron (Crocus sativus L.) aqueous extract against genetic damage induced by anti-tumor agents in mice

The genotoxic potential of anti-tumor drugs limits their efficacy in the treatment of cancers. Since ancient times, saffron (dried stigmas of Crocus sativus L.) has been used as a spice and medicinal herb. Saffron is a rich source of carotenoids and is known for its anti-cancer and antitumor properties. The present study was designed to ascertain the chemoprotective potential of saffron against the genotoxicity of three well-known anti-tumor drugs-cisplatin (CIS), cyclophosphamide (CPH) and mitomycin C (MMC)-using comet assay. Three doses of saffron (20, 40 and 80 mg/kg b.w.) were orally administered to mice for five consecutive days prior to the administration of anti-tumor drugs under investigation. Pre-treatment with saffron significantly inhibited anti-tumor drugs induced cellular DNA damage (strand breaks) as revealed by decreased comet tail length, tail moment and percent DNA in the tail. These findings, together with our previous results, suggest a potential role for saffron as an anti-genotoxic, anti-oxidant and chemopreventive agent and could be used as an adjuvant in chemotherapeutic applications.

Studies on the synthesis, characterization, human serum albumin binding and biological activity of single chain surfactant-cobalt(III) complexes

The interaction of surfactant-cobalt(III) complexes [Co(bpy)(dien)TA](ClO4)3 · 3H2O (1) and [Co(dien)(phen)TA](ClO4)3 · 4H2O (2), where bpy = 2,2'-bipyridine, dien = diethylenetriamine, phen = 1,10-phenanthroline and TA = tetradecylamine with human serum albumin (HSA) under physiological conditions was analyzed using steady state, synchronous, 3D fluorescence, UV/visabsorption and circular dichroism spectroscopic techniques. The results show that these complexes cause the fluorescence quenching of HSA through a static mechanism. The binding constant (Kb ) and number of binding-sites (n) were obtained at different temperatures. The corresponding thermodynamic parameters (∆G°, ∆H° and ∆S°) and Ea were also obtained. According to Förster's non-radiation energy transfer theory, the binding distance (r) between the complexes and HSA were calculated. The results of synchronous and 3D fluorescence spectroscopy indicate that the binding process has changed considerably the polarity around the fluorophores, along with changes in the conformation of the protein. The antimicrobial and anticancer activities of the complexes were tested and the results show that the complexes have good activities against pathogenic microorganisms and cancer cells.

Green synthesis and characterization of selenium nanoparticles and its augmented cytotoxicity with doxorubicin on cancer cells

Green synthesis of selenium nanoparticles (SeNPs) was achieved by a simple biological procedure using the reducing power of fenugreek seed extract. This method is capable of producing SeNPs in a size range of about 50-150 nm, under ambient conditions. The synthesized nanoparticles can be separated easily from the aqueous sols by a high-speed centrifuge. These selenium nanoparticles were characterized by UV-Vis spectroscopy, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and elemental analysis by X-ray fluorescence spectrometer (XRF). Nanocrystalline SeNPs were obtained without post-annealing treatment. FTIR spectrum confirms the presence of various functional groups in the plant extract, which may possibly influence the reduction process and stabilization of nanoparticles. The cytotoxicity of SeNPs was assayed against human breast-cancer cells (MCF-7). It was found that SeNPs are able to inhibit the cell growth by dose-dependent manner. In addition, combination of SeNPs and doxorubicin shows better anticancer effect than individual treatments.

Biogenic silver nanoparticles for cancer treatment: an experimental report

A generation of nanoparticles research has discussed recently. It is mandatory to elaborate the applications of biogenic nanoparticles in general and anticancereous property in particular. The present study was aimed to investigate the in vitro cytotoxicity effect of biogenic silver nanoparticles (AgNPs) against human breast cancer (MCF-7) cells towards the development of anticancer agent. Biogenic AgNPs were achieved by employing Sesbania grandiflora leaf extract as a novel reducing agent. It was well characterized by FESEM, EDAX and spectral studies showed spherical shaped nanoparticles in the size of 22 nm in slightly agglomerated form. It was surprising that biogenic AgNPs showed cytotoxic effect against MCF-7 cell lines were confirmed by MTT, AO-EB, Hochest and COMET assays. There was an immediate induction of cellular damage in terms of loss of cell membrane integrity, oxidative stress and apoptosis were found in the cell which treated with AgNPs. This may be a first report on anti-MCF-7 property of biogenic AgNPs in the fourth generation of nanoparticles research. It is necessary to study the formulation and clinical trials to establish the nano drug to treat cancer cells.

The inhibitory effect of sodium selenite on N-nitrosodiethylamine-induced and phenobarbital promoted liver tumourigenesis in rats based on the modulation of polyamine levels

In the present study, we have evaluated the effects of dietary selenite (Se) on polyamine levels and its influence on N-nitrosodiethylamine (DEN) initiated and Phenobarbital (PB) promoted in rat liver carcinogenesis. Dietary selenite at a concentration of 4 ppm (through drinking water) was administered in rats either before initiation (4 weeks), or during promotion (16 weeks) and entire experimental period (20 weeks). Male Wistar strain of albino rats was treated with single intra peritoneal dose of DEN (200 mg kg(-1) body weight), after 2 weeks the carcinogenic effect was promoted by PB (0.05%; through diet). Alpha fetoprotein (AFP) was investigated after the 20th-week of experimental period. Selenite-treated animals markedly reduced the AFP during the time of pre-selenite [before initiation (4 weeks)] and entire experimental period (20 weeks), administration rather than the promotion period. This infers that anticancer property of selenite depends on the stage of carcinogenesis, rather than duration of treatment. Evaluation of polyamine levels in hepatoma and surrounding liver tissue showed significant difference in the selenite-treated groups compared with pair-fed control groups. Furthermore, histopathological examination showing remarkable difference between control and treated groups. These results demonstrate that selenite can modulate the development of DEN-induced and PB-promoted rat liver carcinogenesis through a polyamine-dependent mechanism.

Protective effect of Spirulina fusiformis on chemical-induced genotoxicity in mice

Spirulina fusiformis given by oral route to mice at doses of 250, 500 and 1000 mg kg(-1) significantly inhibit the genotoxicity induced by cisplatin and urethane. In addition, a significant reduction in the extent of lipid peroxidation with concomitant increase in the liver enzymatic (GPx, GST, SOD, CAT) and non-enzymatic (reduced glutathione) antioxidants were observed.

Protective effects of saffron (Crocus sativus Linn.) on genotoxins-induced oxidative stress in Swiss albino mice

The modifying effects of the aqueous extract of saffron (dried stigmas of Crocus sativus Linn.) on cisplatin (CIS), cyclophosphamide (CPH), mitomycin-C (MMC) and urethane (URE) induced alterations in lipid peroxidation and antioxidant status were investigated in Swiss albino mice. Three doses of saffron (20, 40 and 80 mg/kg body weight) were orally administered to mice for 5 consecutive days prior to administration of genotoxins. A significant reduction in the extent of lipid peroxidation with a concomitant increase in the liver enzymatic (SOD, CAT, GST, GPx) and non-enzymatic antioxidants (reduced glutathione) were observed in saffron pretreated animals compared with the genotoxins alone treated animals. However, the modulatory effects were not always dose dependent. Our data suggest that saffron may exert its chemopreventive effects by modulation of lipid peroxidation, antioxidants and detoxification systems.

Effect of Spirulina fusiformis on cyclophosphamide and mitomycin-C induced genotoxicity and oxidative stress in mice

Spirulina fusiformis was tested for its possible in vivo protective effects against cyclophosphamide (CP) and mitomycin-C (MMC) induced genotoxicity and oxidative stress in mice. Pre-treatment with S. fusiformis (250, 500 and 1000 mg kg(-1), p.o., daily for 5 days) significantly reduced the chromosomal damage and lipid peroxidation with concomitant changes in antioxidants and detoxification systems. All the three tested doses were effective in exerting a protective effect against CP and MMC.

Inhibition of genotoxicity by saffron (Crocus sativus L.) in mice

Experiments were carried out to ascertain whether or not saffron (dried stigmas of Crocus sativus L.), a commonly used agent for flavoring and coloring food can exert modulatory effects on the in vivo genotoxicity of cisplatin (CIS), cyclophosphamide (CPH), mitomycin C (MMC) and urethane (URE). For this purpose, Swiss albino mice were pretreated for five consecutive days with three doses (20, 40 and 80 mg/kg body weight) of the aqueous extract of saffron. Genotoxic effects were assessed in the mouse bone marrow micronucleus test. The results obtained suggest that pretreatment with saffron can significantly inhibit the genotoxicity of CIS, CPH, MMC and URE. This inhibitory effect was not always dose-dependent. In addition, the hepatic glutathione S-transferase (GST) activity was assessed in the control and treated animals. No significant change in GST activity was observed after pretreatment with saffron alone. Treatment with the genotoxins alone significantly inhibited GST activity. Saffron pretreatment attenuated the inhibitory effects of the genotoxins on GST activity.

Neonatal sepsis: Staphylococcus aureus as the predominant pathogen

96 consecutive inborn neonates with blood culture proven bacterial sepsis during the period January to June 1997 were studied. Lethargy with refusal of feeds (28%), fever (28%) and respiratory distress (31.3%) were the major presenting features. Half of them (n = 48) were of early onset (< 48 hours) and the remaining half were of late onset (> 48 hours). Staphylococcus aureus (n = 59, 61.5%) was the predominant pathogen and 66% of them were methicillin resistant followed by Klebsiella pneumoniae (n = 24, 21.9), Escherichia coli (n = 13, 13.5%) and streptococci (n = 3, 3.1%). Antibiotic resistance was common, with the sensitivity to various antibiotics being ampicillin 19%, gentamicin 21.6%, cefotaxime 32.8%, amikacin 50%, chloromycetin 59.6% and ciprofloxacin 90.3%.

Development and validation of an evaluation tool for multimedia resources in health education

The last decade saw a rapid increase in the use of multimedia in health education. Easy availability, accessibility, low cost of technological resources and the expanding body of research on the role of multimedia in student learning, among others, have all contributed to this increase in usage. Since one of the roles of educators is to assess and select learning resources based on curriculum goals and student needs, the development of standardized methods for multimedia evaluation becomes vital. To the learner, it is important for reviews of the quality of the resource to be readily available. An evaluation too was developed based on the recognition of this need. The validity of the tool was tested using experts in technology and education. Reliability was determined using faculty and students who reviewed the same software, using the tool. In addition, graduate students reviewed two versions of a nursing program, of varying quality. The results indicate that the tool is reliable and valid. It is envisaged that this tool can be utilized by health educators for evaluating multimedia resources and setting up a much needed clearinghouse for health education resources.

Technology-based dissemination

Health care reform and restructuring, changes in the scope and definitions of 'health', 'health care' and 'health research', along with a continued emphasis on multidisciplinary health promotion and prevention, all indicate the need for information dissemination, exchange and management. Technology can be a tool to help meet this need, as it can help us disseminate, as well as understand the process of dissemination. Rapid advances in, and reduced costs of technology, permit the integration of this tool. This paper provides a definition for dissemination, along with a background and rationale as to why now is the time and place to harness technology to assist with the dissemination process. In addition, it presents well-designed studies on the effective use of technology as an aid to dissemination. Concrete examples of innovative technology that are being tested are also examined. Finally, the challenge and strategies for technology integration are addressed.

A learning resources centre: its utilization by medical students

Innovations in medical education have led to the increasing use of problem-based learning techniques, a committee system organization, and more time for independent study in many undergraduate programmes. There has been an increase in availability of alternative methods for presentation of information. To encourage self-directed learning, resources such as computers, videos and models, among others, should be readily available to students. The University of Calgary Faculty of Medicine has provided various resources contained in one area, called the Bacs Learning Resource Centre (BLRC). Since the maintenance and further development of such a centre requires significant resources, it is important to determine student utilization of the various components used in their learning. For those who are about to set up such a learning resource centre this information gives guidance on which materials are most useful. The utilization of the centre by 69 first year medical students was studied using questionnaires. The utilization during a specific course was determined by analysing the entries in the individual log books given to the students at the beginning of the Integrative Course. With the exception of one student, all those who responded to the questionnaire used the Centre, with 20% or less of their total study time being spent there. The BLRC was most used for the Musculoskeletal, Cardiovascular and Reticulo-Endothelial courses. All categories of resources were found to be useful, with the tape/slides least utilized. Utilization was most influenced by the quality of resources available and recommendations by peers. The development of a centre such as the BLRC, with a variety of resources concentrated in one area, suitable for individual or group study and accessible 24 hours a day, should be considered by all medical schools to enhance self-directed learning in medical students.

Telemedicine and security. Confidentiality, integrity, and availability: a Canadian perspective

The health care system is undergoing major reform, characterized by organized delivery systems (regionalization, decentralization, devolution, etc); shifts in care delivery sites; changing health provider roles; increasing consumer responsibilities; and accountability. Rapid advances in information technology and telecommunications have led to a new type of information infrastructure which can play a major role in this reform. Compatible health information systems are now being integrated and connected across institutional, regional, and sectorial boundaries. In the near future, these information systems will readily be accessed and shared by health providers, researchers, policy makers, health consumers, and the public. SECURITY is a critical characteristic of any health information system. This paper will address three fields associated with SECURITY: confidentiality, integrity, and availability. These will be defined and examined as they relate to specific aspects of Telemedicine, such as electronic integrated records and clinical databases; electronic transfer of documents; as well as data storage and disposal. The guiding principles, standards, and safeguards being considered and put in place to ensure that telemedicine information intrastructures can protect and benefit all stakeholders' rights and needs in both primary and secondary uses of information will be reviewed. Implemented, proposed, and tested institutional, System, and Network solutions will be discussed; for example, encryption-decryption methods; data transfer standards; individual and terminal access and entry I.D. and password levels; smart card access and PIN number control; data loss prevention strategies; interference alerts; information access keys; algorithm safeguards; and active marketing to users of standards and principles. Issues such as policy, implementation, and ownership will be addressed.

Effects of short-term isotonic & isometric training on cardiovascular & pulmonary function

A randomised control trial of short-term exercises on specific cardiovascular and respiratory parameters was undertaken in normal male college students. The effects of isotonic training (5BX programme) and isometric training (a programme of isometric exercises working all major groups of muscles) were compared with a control group with no specific workout. Both isotonic and isometric training resulted in significant cardiovascular improvement but seemed inadequate to improve vital capacity and flow rates. Isotonic training in addition, improved ventilatory efficiency. It is concluded that such isotonic or isometric training of thrice a week for ten weeks, requiring no equipment, less time and space can be promoted to improve physical fitness.

Exercise induced bronchial lability in normal men and women--a comparison

Normal male (n = 29) and female (n = 39) medical students with a mean age of 19.2 years who were nonsmokers, with no personal history of allergy were studied. The bronchial lability was assessed from peak expiratory flows and forced expiratory spirograms taken before, during and upto 45 minutes after a standard exercise using the Harvard steps. Women had a significantly lower (P < .001) resting FVC, FEV1, FEF 25-75% and PEF as compared to men. Although the exercise lability index was not significantly different in men and women, the latter showed a greater percent increase (P < .02) and a lesser percent decrease (P < .02) of PEF during and after the exercise respectively. They also showed a significantly (P < .005) faster recovery to normal. These results suggest that airway dynamics may be better in women than in men. This could account for the lower incidence and morbidity from respiratory allergic disease seen in women as compared to men.