Determining the Prevalence of Molecular Subtypes of Colorectal Cancer in the Indigenous Population of Uganda: Focus on Jass Classification and Lynch Syndrome | Chapter 6 | Medical Science: Updates and Prospects Vol. 6

 

Introduction: Colorectal cancer is the third most common cancer and the second most common cause of cancer mortality worldwide. There are disparities in the epidemiology of colorectal cancer across different populations, most probably due to differences in exposure to lifestyle and environmental factors related to colorectal cancer. In the next decade, East Africa is predicted to face an unprecedented growth of cancers, including colorectal cancer. There are indications of a significant burden of late-stage and aggressive colorectal cancer in the Ugandan population. Survival rates in SubSaharan Africa remain poor, with Uganda registering a low 3-year overall survival of 33.3%. There is a paucity of data on colorectal cancer molecular subtypes and their characteristics among patients in East Africa.

 

Objective: The objective is to determine the prevalence of colorectal cancer molecular subtypes among Ugandan colorectal cancer patients.

 

Methodology: A descriptive cross-sectional study was conducted in two referral hospitals and two missionary hospitals in Uganda. Data was obtained on demographics, topography of tumour and stage. The histopathological subtype, grade and LVI status of CRC were obtained from H&E slides. Immunohistochemistry was carried out to determine whether PMS2 and MLH1 were MMR-deficient or proficient. CRC formalin-fixed paraffin-embedded (FFPE) tissue blocks were used to extract DNA. The MLH-1, MSH2, MSH6, BRAF and KRAS genes were sequenced using NGS sequencing, and the CIMP status was obtained using targeted NextGen Bisulphite sequencing (tNGBS). The tumour molecular subtypes were defined according to the Jass classification: Type 1: MSI positive, CIMP-positive, BRAF-mutated (positive), K-ras mutation negative; Type 2: MSS (MSI negative), CIMP-positive, BRAF-mutated (positive), Kras-mutation (negative); Type 3: MSS (MSI negative), CIMP-negative, BRAF-mutation negative, Kras mutated (positive); Type 4: MSS (MSI negative), CIMP-negative, BRAF-mutation negative, Kras-mutation negative.; Type 5: MSI positive, CIMP-negative, BRAF mutation-negative, Kras-mutation negative (Lynch syndrome). Other marker combinations were grouped together as “other category”. Categorical data were summarised using proportions and frequencies corresponding to the MSI status and each of the five molecular subtypes defined using the Jass classification. Categorical and continuous variables were analysed using the Chi-square and Fisher’s exact tests. For all the analyses, a p-value ≤0.05 was considered statistically significant.

 

Results: Out of 127 CRC patients, the median (IQR) age was 54(43-67) years. Advanced stage III+IV was found in 109(85.8%) cases. Poorly differentiated tumours constituted 14(11.02%), moderately differentiated 96(75.6%) and well differentiated 17(13.4%). There were 52(40.9%) MSI positive tumours and 75(59.06%) MSS tumours. The molecular subtypes defined by the Jass classification included 0% type I, 2.3% type 2, 3.3% type 3, 45.7% type 4, and 38.0% type 5 (Lynch syndrome). Colorectal cancer patients with Lynch syndrome have a pathogenic germline variant in one MMR gene and a secondary gene inactivation due to promoter hypermethylation or loss of heterozygosity.

 

Conclusions: Importantly, sporadic MSI-high/CIMP-high tumours (Jass type 1) were not present (0%), and BRAF/KRAS pathogenic mutations were infrequent, unlike tumours from the Western world. Many young CRC participants presented with poorly differentiated and advanced-stage tumours, with MSI-positive tumours mainly due to Lynch syndrome. Immunohistochemistry, MSI testing and colonoscopic surveillance are cheaper than germline testing, and in Uganda may be carried out on CRC patients with MSI-positive histology.

 

 

Author(s) Details

R. Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University of Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

R. Matthews
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

C. Whalley
Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

 

J. Kiwanuka
Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda.

 

F. E. Kakembo
Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Healt
Sciences, Makerere University, Kampala, Uganda and African Centre of Excellence in Bioinformatics and Data Intensive Sciences, Infectious, Diseases Institute, Makerere University, Kampala, Uganda.

 

S. Thorn
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

H. Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

M. Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

I. Tomlinson
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v6/7150

 

Diagnostic Accuracy of Barium Enema in Colorectal Cancer: A Histopathological Correlation Study | Chapter 1 | Medical Science: Updates and Prospects Vol. 7

 

Background: Colorectal cancer is a disorder that occurs exclusively in the colon or rectum and is caused by the colon’s aberrant proliferation of glandular epithelial cells. Two commonly used strategies for initial evaluation are Double Contrast Barium Enema (DCBE) and diagnostic lower GI endoscopy. Barium enema is easy to perform, does not require sedation, is inexpensive, and is readily available in Bangladesh. However, limited data are available on its diagnostic accuracy in the local population.

 

Aim of the Study: This study aims to determine the diagnostic value of barium enema in colorectal cancer.

 

Materials and Methods: A prospective study was carried out on 50 cases presented with clinical features of colorectal cancer in Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and National Institute of Cancer Research & Hospital (NICRH) during the period July 2000 to June 2001. Of the 50 patients, 30 were male, and 20 were female. The mean age of the male patients was 46 ± 10.8 years, while that of the female patients was 44.5 ± 11.2 years. All 50 cases underwent barium enema examination under fluoroscopic control; single-contrast studies were performed in 11 cases, and double-contrast studies were performed in 39 cases. The findings of barium enema examination were confirmed by histologic examination of the specimens obtained by colonoscopy, and in 10 cases, after operation. Moreover, questionnaires, interviews, case history and clinical examinations were conducted to collect all the relevant data and analysed statistically.

 

Results: No statistically significant difference was found between the age and sex of the patients. In Western countries, colorectal cancer typically occurs in late adulthood, most commonly in the sixth and seventh decades of life; however, in this study, the highest incidence was observed in the fourth and fifth decades, followed by the sixth decade. Males predominate over females, and the rectum is more involved than the colon. It was found that 96% of patients took meat and fat, and one patient had a family history of colon cancer. Colorectal cancer was more common (44%) in better socio-economic conditions than in low (4%). Constipation (70%) and per rectal bleeding (64%) were predominant symptoms, and 68% cases had abnormality in per rectal examination. Out of 40 cases, colonoscopy detected a lesion in 33 cases, one was a false positive, and 7 cases were negative; of them, 3 cases were false negatives, and 4 were true negatives. In 50 cases, barium enema detected a lesion in 42 cases; 2 were false positives. 8 cases were negative in barium enema, of them 5 were false negatives, and 3 were true negatives. Histologically, 45 (90%) cases proved to be adenocarcinoma, among them 4 (8%) cases were mucinous adenocarcinoma. Five cases were histologically negative. The sensitivity and accuracy of barium enema were 88.9% and 86%, and those of colonoscopy were 91.4% and 90%, respectively.

 

Conclusion: Though colonoscopy has greater sensitivity and accuracy, it is less acceptable to the patients, has a high cost, is not easily available, requires sedation and expertise and the entire colon is not seen in 2-40% of patients. The study concluded that barium enema may be considered a suitable initial investigation for the diagnosis of clinically suspected colorectal cancer. However, as this was a single-centre study with a small sample size, future research should include larger sample sizes and multicenter studies to validate these findings.

 

Author(s) Details

Md. Abdul Gafur
Chittagong Medical College, Chattogram, Bangladesh.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v7/7108

Role of Fusobacterium nucleatum and KRAS Genotype in Colorectal Cancer Development | Chapter 9 | An Overview of Disease and Health Research Vol. 9

 

Fusobacterium nucleatum (Fn) and activating mutations in the Kirsten rat sarcoma viral oncogene homolog (KRAS) are increasingly recognised as synergistic drivers of colorectal cancer (CRC). Fn promotes tumorigenesis through several mechanisms, such as virulence factors including FadA and Fap2. KRAS mutations amplify proliferative and inflammatory signalling. This chapter explores how Fn enhances KRAS-driven oncogenic cascades and how KRAS-mutant epithelium fosters bacterial colonisation. We also examine KRAS as a prognostic biomarker and highlight emerging microbiome-targeted strategies. Understanding this microbial–genetic crosstalk provides a foundation for precision prevention and combined therapeutic approaches in CRC.

 

Author(s) Details

Ahmed Dewan
College of Life Sciences, Anhui Agriculture University, Hefei 230036, China.

 

Ivan Tattoli
Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy.

 

Maria Teresa Mascellino
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.

 

Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v9/7037

Ovarian Mass Leading to the Diagnosis of Krukenberg Tumour: A Case Report | Chapter 2 | Medical Science: Updates and Prospects Vol. 3

 

A Krukenberg tumour is a distinct metastatic ovarian carcinoma, a secondary ovarian malignancy arising from a distant primary site. They often show nonspecific gastrointestinal symptoms, which lead to a delayed diagnosis and a poor prognosis.

 

This case report exemplifies the challenges associated with diagnostic delays of Krukenberg tumours, especially in distinguishing metastatic ovarian tumours from primary ovarian cancer, and the limited treatment options available in the advanced stages of the disease, which can affect patients' prognosis.

 

Histopathological analysis revealed diffusely invasive growing cancerous tissue with granular and diffuse single distribution in which numerous tumour cells had a signet–ring appearance indicative of a Krukenberg tumour from the stomach.  Despite postoperative recovery and subsequent admission for treatment, the patient encountered recurrent obstruction and ultimately succumbed.

 

This report present the case of a 29-year-old woman of African Descent, Gravida 1 para 1, who presented to the accident and emergency room with persistent abdominal pain, distension, and vomiting. Erect Abdominal X-ray demonstrated dilated bowel loops. Transabdominal ultrasonography revealed a complex adnexal mass measuring approximately 13.9 × 8.5 cm, involving the ovary and fallopian tube, extending into the cul-de-sac and Morrison’s pouch. A subsequent CT imaging showed Heterogeneous intraperitoneal pelvic tumours measuring 12.0 × 11.4 × 8.7 cm, associated with ascites and evidence of intestinal obstruction. Free fluid was also noted throughout the peritoneal cavity. The patient underwent an exploratory laparotomy, which identified friable ovarian masses measuring 8 × 10 cm on the left and 10 × 14 cm on the right, along with a 10 × 4 cm omental mass. Additional metastatic deposits were observed on the fallopian tubes, transverse colon, and peritoneum. All grossly visible tumours were surgically excised.

 

This case highlights a rare presentation of bilateral metastatic Krukenberg tumours from primary gastric adenocarcinoma in a young woman. It underscores the diagnostic challenges posed by nonspecific gastrointestinal symptoms and emphasises the importance of early, accurate diagnosis using imaging, endoscopy, histopathology, and immunohistochemistry. Multidisciplinary management is essential to guide surgical, oncologic, and palliative care, optimising outcomes and quality of life even in advanced-stage disease.

 

 

Author(s) Details

Amanda Gray
Department of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, Georgetown, Guyana.

 

Jeniesa Klass
Department of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, Georgetown, Guyana.

 

Malika Bacchus
Department of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, Georgetown, Guyana.

 

Owens Ogbeiwi
Department of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, Georgetown, Guyana.

 

Nirvani Goberdhan
Department of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, Georgetown, Guyana.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v3/6768

Clinical Implications of Tissue Carcinoembryonic Antigen Expression in Ugandan Colorectal Cancer Patients | Chapter 10 | Medicine and Medical Research: New Perspectives Vol. 9

 

Introduction: Globally colorectal cancer (CRC) is the third most common malignancy. The global incidence of colorectal cancer (CRC) is projected to rise up to 60% in 2030. In Uganda and other resource-deprived countries in Sub-Saharan Africa, colonoscopy is not easily accessible for screening. Therefore, carcinoembryonic antigen (CEA) may have a larger role as a marker for CRC development in these resource-limited settings. The aim of this study was to investigate the incidence of positive CEA in CRC tissue and compare it to clinicopathological features in Ugandan patients.

Methods: From 16th September 2019 to 16th September 2021, samples of colorectal biopsy specimens and resected colorectal carcinoma specimens were obtained from patients in Masaka Regional Referral Hospital, Mulago National Referral Hospital, Uganda Martyrs’ Hospital Lubaga and Mengo Hospital. Participants were consecutively recruited from hospitals in central Uganda between 2019-2021, with corresponding formalin-fixed and paraffin-embedded (FFPE) tissue blocks that were included in the CEA analysis. A Data Extraction Form was used to obtain data regarding age, sex, stage, grade of colorectal cancer, and topography. Haematoxylin and eosin sections from FFPE CRC blocks were prepared to establish the grade, lymphovascular invasion (LVI), and histopathological subtype. The CEA molecular marker was analysed using the ABC method for immunohistochemistry. The Pearson chi-square test was used to assess the association between CEA expression and demographic and histopathological variables. The correlation between the CEA biomarker and grade was determined using Spearman’s rank correlation. A p-value of ≤0.05 was considered statistically significant.

Results: The present study evaluated the CRC tissue CEA and the correlation of the tissue staining intensity with the grade, stage, LVI status, topography, and histopathological subtype of CRC. Out of 118 participants, there were 67 male participants and 52 female participants and the median age (SD) for all the participants was 59.9(15.3) years. Compared to stage I, there were 31.4% of CRC tissues stained positively for CEA in stage IV disease and this reached statistical significance (p=0.0101). There were 73.4% CRC tissues with grade II CRC that stained positively for CEA compared to 15.2% CRC tissues with grade I CRC (p=0.0000). There were more AC (85%) participants that stained positively for CEA compared to MAC (5.8%) and SRCC (9.2%) participants (p=0.0000). A positive correlation between tumour grade and CEA expression was found (r=+0.2204) (p=0.0232).

Conclusions: In Uganda, increasing CEA intensity in CRC tissues is associated with a poorer grade. High-grade CRC has a higher incidence of lymph node metastasis and a higher CRC CEA tissue expression. Therefore, in Uganda, there is a poorer prognosis for patients expressing high levels of CEA in their colorectal cancer tissue. The number of rectal cancer patients excluded due to neoadjuvant chemoradiotherapy was small and therefore it is unlikely that selection bias was introduced. The effect of neoadjuvant chemoradiotherapy on tissue CEA expression should be explored in future studies.

 

Author (s) Details

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Josephat Jombwe
Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.

 

Emmanuel Elobu
Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v9/2388

Rising Trends in Early-Onset Colorectal Cancer: Epidemiological Insights and Future Directions in Multimodal Treatment and Prevention |Chapter 7 | Medicine and Medical Research: New Perspectives Vol. 9

People under the age of 50 are experiencing an increasing incidence of early-onset colorectal cancer (CRC), as well as an increasing mortality rate associated with the disease. This is a well-known fact. As a result of these patterns, a flurry of research has been conducted with the objective of elucidating the epidemiology and characteristics of colorectal cancer that manifests at an early stage, as well as developing strategies for early detection and prevention.

There are two methods that can be utilised in order to identify and prevent early-onset colorectal cancer (CRC) in young adults who do not exhibit any symptoms: There are two types of screening: 1) population-based screening for individuals who would otherwise be considered to be at average risk, and 2) precision screening, which takes into account factors such as genetics, lifestyle, and family history. Initiating early screening based on family history is the primary precision screening technique that is recommended for the early detection and prevention of early-onset CRC. This technique is also known as genetic screening.  However, the most important thing that should we do is early screening for this specific age group.

 

Author (s) Details

Budhi Ida Bagus
Department of Surgery, Sebelas Maret University, Indonesia.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v9/2487

 

GNAS Mutation Patterns in Colorectal Cancer: Insights from a Ugandan Cohort | Chapter 7 | Medical Science: Recent Advances and Applications Vol. 3

Introduction: In Uganda, the incidence of colorectal cancer (CRC) is rising, though still relatively low compared to developed countries, with a 5-year survival rate of 5.6%. Western literature shows that GNAS mutations are linked with failed treatment outcomes and a poor prognosis in CRC. The GNAS gene mutations are detected in many tumour types, as with KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations. The global prevalence of the GNAS mutation in colorectal tumours varies.

Study Objective: The objective of this study was to determine the prevalence of pathological GNAS gene mutations and compare them to the clinicopathological features of CRC in Ugandan patients.

Methodology: The participants attending the Surgical Departments of Masaka Regional Referral Hospital, Mulago National Referral Hospital, Uganda Martyrs’ Hospital, Lusaka, and Mengo Hospital were prospectively recruited. This was a cross-sectional study in which formalin-fixed paraffin-embedded (FFPE) CRC blocks were obtained from 2008 to 2021. The histopathological diagnosis of colorectal adenocarcinoma, grade and LVI status was obtained by two consultant pathologists from the H&E slides. Data was abstracted from the medical case files for AJCC stage, topography and demographics. DNA was extracted from CRC FFPE tissue blocks, and using the Qiagen custom design panel, library preparation was completed. There were 56 genes which were represented in the custom panel. The GNAS gene was sequenced using the above library preparation and NGS sequencing. Categorical data were summarised using proportions and frequencies corresponding to the GNAS mutation status. Categorical and continuous variables were analysed using Fischer’s exact tests and chi-square tests. A p-value of ≤0.05 was considered statistically significant.

Results: There were 127 CRC participants with a mean (SD) age of 54.9(16.0) years. The male: female ratio was 1.2. Late-stage (III+IV) CRC constituted 85.8% of CRC participants. The majority were moderately differentiated CRC (75.6%) and had positive lymphovascular invasion (89.8%). The majority of tumours were in the rectum (44.8%), and 74% were left-sided colon tumours. There were 36(28.3%) colorectal tumours that were GNAS mutation positive. Out of the MSI tumours, there were 18(50%) GNAS-positive tumours and 34(37.4%) GNAS-negative tumours (p=0.192). There were 4(11.1%) GNAS-positive tumours compared to 16(17.6%) GNAS-negative tumours with stage IV disease (p=0.301). Out of the tumours that were GNAS mutation positive, 40(31.5%) were KRAS mutation negative and 4(3.1%) were KRAS mutation positive (p=0.447).

Conclusions: In Uganda, the prevalence of GNAS mutations is similar to the prevalence from Japan, however, different to the prevalence reported in other countries. There was no relation between GNAS mutation and demographics, topography, grade, LVI status, stage, MSI status and K-ras mutation status in Ugandan CRC patients. This is the first study in Uganda and in East Africa which has reported on the prevalence of GNAS gene mutations in CRC patients, so further studies are required in this context.

 

Author (s) Details

 Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University of Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda, Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Rosie Matthews
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Celina Whalley
Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Fredrick Elishama Kakembo
Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and African Centre of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda.

 

 

Steve Thorn
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Ian Tomlinson
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v3/5345

Low Prevalence of CpG Island Methylator Phenotype (CIMP) in Ugandan Colorectal Cancer: A Molecular and Clinicopathological Analysis | Chapter 7 | Disease and Health: Research Developments Vol. 9

Introduction: Genetic and epigenetic aberrations are responsible for the development of colorectal cancer (CRC) that are inherited or gained during life, or both. A number of risk factors for CRC have been determined in epidemiologic studies which include age, obesity, race, diet, cigarette smoking, inflammatory bowel disease, family history of colon cancer, intake of alcohol and physical inactivity. A recognized subgroup of colorectal cancer (CRC) known as CpG island methylator phenotype (CIMP) is associated with particular patient outcomes and genetic defects in developed high-income countries. CIMP is a well-defined epigenetic subtype in CRC, but its prevalence in African populations remains understudied. In Uganda, the CIMP status of colorectal cancer has not been determined despite the increase in the incidence of CRC according to the Kampala Cancer Registry. Hence the objective of this cross-sectional study was to determine the CIMP status of colorectal cancer in Ugandan patients.

Methodology: This was a retrospective study carried out between 2008 and 2021 involving formalin fixed paraffin embedded CRC tissue blocks. Next-generation sequencing (NGS) was used to interrogate pathogenic variants which were present in the MMR genes, BRAFV600E and KRAS. The MSI status was also obtained using immunohistochemistry on MLH1, MSH2, MSH6 and PMS2. Targeted NextGen Bisulphite Sequencing was used for CIMP testing based on a validated quantitative DNA methylation assay. We analyzed CIMP status in 92 CRC patients using a 13-gene panel which included APC, CACNA1G (MINT31), CDKN2A, CRABP1, IGF2, IGFBP3, MGMT, RASSF1, SEPTIN9, SFRP2, SOCS1, SV2C(MINT 1), TMEFF1(HPP1), and WIFI. CIMP was defined as ≥6/13 methylated genes.

Results:  Out of 92 cases which had an adequate quantity of DNA to carry out CIMP analysis, 11(11.9%) were CIMP positive and 81(88.0%) were CIMP negative. CIMP-positive tumours represented 3(5.8%) of MSI-positive tumours compared with 8(10.7%) of MSS tumours and this did not reach statistical significance (p=0.516). CIMP was associated with BRAF mutation (p=0.013). There were 7(11.1%) CIMP-positive tumours in the left colon and 4(13.8%) CIMP-positive tumours in the right colon and this did not reach statistical significance (p=0.713). There were 5(3.9%) colorectal tumours having pathologic missense BRAF V600 mutations and 8(6.3%) colorectal tumours having pathologic missense KRAS mutations.

Conclusions: In contrast to Western studies, Ugandan colorectal tumours exhibited low BRAF and KRAS mutation rates. There was a lack of association between MSI and CIMP which differs from global trends. However, in keeping with studies from the West, there was an association between CIMP and BRAF mutation. Compared to Western developed high-income countries, in Uganda the prevalence of CIMP-positive tumours is low. CIMP is a distinct epigenetic subtype of colorectal cancer in Ugandan patients. The low CIMP prevalence suggests potential ethnic or regional variations in CRC pathogenesis, warranting further study.

 

Author (s) Details

 

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University of Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Rosie Matthews
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Celina Whalley
Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Fredrick Elishama Kakembo
Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and African Centre of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda.

 

Steve Thorn
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere
University, Kampala, Uganda.

 

Michael Odida

Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Ian Tomlinson
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrd/v9/5137

Comparison of Plasma Carcinoembryonic Antigen Levels to Clinicopathological Features of Colorectal Cancer in Ugandan Patients | Chapter 6 | Achievements and Challenges of Medicine and Medical Science Vol. 2

Introduction: Carcinoembryonic antigen (CEA) is the most widely used tumour marker in Uganda and globally. In 1965 Gold and Freedman observed that the CEA molecular marker is present in fetal gut tissues and in tumours of the gastrointestinal tract. Factors which have been found to affect plasma CEA levels include tumour grade, stage, location of the tumour, ploidy status of the tumour, absence or presence of bowel obstruction and liver status. This study aimed to investigate the preoperative plasma CEA level and compare it to clinicopathological features in Ugandan colorectal cancer patients.

Methodology: A prospective observational study was used on 119 recruited colorectal cancer (CRC) participants. Using a standard pretested Data Extraction Form, data for all the participants was extracted from the clinical patients’ files in the respective hospitals. A 10 ml blood sample was taken preoperatively from all the participants to obtain the CEA level in ng/ml. ANOVA and student’s t-test were used to compare mean CEA levels. Pearson chi-square tests were used to determine any association between CEA levels and clinicopathological variables. A p-value of ≤0.05 was statistically significant.

Results: The mean age of all the participants was 55.9(+/-15.3) years whilst the mean CEA level was 23.6(+/-8.51) ng/ml. There was no significant difference between preoperative plasma CEA and topography (p=0.775), stage (p=0.813), grade (p=0.505) and histopathological subtype (p=0.940).

Conclusions: There was no difference in preoperative plasma CEA levels based on histopathological grade, stage, topography and histopathological subtype of CRC in Ugandan patients. Therefore, the plasma CEA levels in Ugandan patients did not increase with increasing histopathological grade and stage and were not affected by the location and histopathological subtype of the colorectal tumour.

 

Author (s) Details

 

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v2/2957

Association between Plasma CEA Level and Tissue CEA Density with Clinical and Histopathological Features of Colorectal Cancer | Chapter 9 | Achievements and Challenges of Medicine and Medical Science Vol. 1

Aim: The objectives of this study were to correlate elevations in plasma CEA levels with the extent of tissue CEA and determine the association of clinicopathological features with tissue CEA in primary tumours in Uganda.

Introduction: Circulating levels of carcinoembryonic antigen (CEA) are widely accepted after primary tumour resection to monitor tumour recurrence and this marker has proved to be useful in the management of colorectal cancer. In Uganda and most parts of the world, carcinoembryonic antigen (CEA) is the most widely used tumour marker. This marker monitors tumour recurrence and is useful in the management of colorectal cancer (CRC). The aim of this study was to correlate elevations in plasma CEA levels with the extent of tissue CEA and determine the association of clinicopathological features with tissue CEA in Ugandan colorectal tumours.  Preoperative elevation of CEA, and the degree of elevation, is associated with an increased risk of recurrence and decreased long-term survival.

Methodology: A total of 119 patients with colorectal cancer specimens from September 2019 to September 2021 were recruited from four hospitals in central Uganda. A preoperative blood sample and the corresponding formalin fixed paraffin embedded tissue block were obtained from all participants. Data was abstracted from the clinical patients’ files on age, sex, stage, grade and topography of CRC. Haematoxylin and eosin sections were prepared to determine the histopathological subtype, grade, and lymphovascular invasion status. The plasma CEA levels were determined and the tissue CEA expression was detected using the indirect immunoperoxidase method which used monoclonal antibody CEA, DAKO Agilent USA< Clone I17 and reference IR622. Pearson chi-square test was used to assess the association between CEA expression and demographic and histopathological variables. Analysis of variance (ANOVA) was used to compare average plasma CEA levels (ng/ml) to tissue CEA intensities. Results: There were 31.4% CRC tissues in stage IV that stained positively for CEA compared to stage I (p=0.0101). Compared to 73.4% with grade II CRC which stained positively for CEA, there were 15.2% of CRC tissues with grade I that stained positively for CEA (p=0.0000). A positive correlation was found between the CRC tissue CEA and grade of CRC (r=+0.2204) and this reached statistical significance (p=0.0232). There was no relation between preoperative plasma CEA level and the CEA in the CRC tissue.

Conclusions: This study showed a significant correlation between the grade of CRC and CRC CEA tissue expression. A higher incidence of lymph node metastasis is associated with a poorly differentiated CRC and a higher CRC tissue CEA expression. There was no correlation found between preoperative plasma CEA and tissue CEA. The study finding suggests a poorer prognosis for patients expressing high levels of CEA in their colorectal cancer tissue in Uganda.

 

Author (s) Details

 

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Henry Wabinga
Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v1/2819

Genetic Nonpolyposis Colorectal Cancer Prediction Using mRNA MSH2 Quantitative Analysis and Its Association with Immutable Factors | Chapter 3 | Current Innovations in Disease and Health Research Vol. 9

 This member aimed to compute acceptable MSH2 gene verbalization for appropriate cut-off and certify the unions from the risk factors. A mainly inherited syndrome of colorectal malignancy (CRC), hereditary non-polyposis colon tumor carries a higher risk for the more immature population. Premature research links the Amsterdam and Bethesda criteria, as well as Deoxyribonucleic acid sequence variety, to its vulnerability. However, those are not applicable.The cross-divided study observed 71 respondents from Concede possibility 2018 to December 2019 in determining the CRC inherited status through MSH2 mRNA expression utilizing reverse transcription-polymerase chemical reaction and the disease’s risk factors. Dossier were analyzed through U.s. city-Square, Fischer exact, t-test, Mann- Whitney, and multiple logistics. It is disclosed that MSH2 levels in tissue and ancestry within the CRC group differ considerably, but there are no meaningful differences across the groups. The hereditary CRC halt is 11059 fc through the blood deoxyribonucleic acid expression fifth percentile, isolating the 40 CRC responses into 32.5% accompanying hereditary CRC.  CRC higher predominance in the male gender is the result of female protectiveness from the affliction. The sex hormone of estradiol and progesterone acts as guarding mechanism for CRC growth in the body. The hormonal clinical trial in 2019 note that introduction of estradiol and progesterone mixture treatment provide raised apoptosis of tumor containers (P < 0.05) while lowering tumor container proliferations (P < 0.01). Significant risk determinants include age, family history, and arranging. Nonetheless, following in position or time multivariate control, age is just a confounder. Further, the study develops a probability equating with extent under the curve 82.2%.The heredity of CRC patients is considerably influenced by a off-course range of factors. But while age and other variables are confusing factors, arranging and family history are very key factors. The study more established a positive cut-off point for heredity CRC established mRNA MSH2 expression, 11059 fc. These verdicts shall act as factual foundations on further risk determinants and/or genetical CRC future studies.

Author(s) Details:

Tjahjadi Robert Tedjasaputra,
Department of Internal Medicine, Tarakan General Hospital, Medical Faculty University of Hasanuddin, Jakarta 10720, DKI Jakarta, Indonesia.

Mochammad Hatta,
Department of Immunology and Biomolecular, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia.

Muh Nasrum Massi,
Department of Microbiology, Faculty of Medicine, University of Hasanuddin, Makassar 90245, South Sulawesi, Indonesia.

Rosdiana Natzir,
Department of Biochemistry, Medical Faculty, University of Hasanuddin, Makassar 90245, South Sulawesi, Indonesia.

Agussalim Bukhari,
Department of Nutrition, Faculty of Medicine, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia.

Rina Masadah,
Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar 20945, South Sulawesi, Indonesia.

Muh Lutfi Parewangi,
Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 20945, South Sulawesi, Indonesia.

Prihantono Prihantono,
Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar 90245, South Sulawesi, Indonesia.

Rinda Nariswati,
Department of Statistic, School of Computer Science, Bina Nusantara University Jakarta, Jakarta 11530, Indonesia.

 
Vincent Tedjasaputra,
American Association for the Advancement of Science (AAAS), Science and Technology Policy Fellow, Alexandria, VA 22314, United States.

Please see the link here: https://stm.bookpi.org/CIDHR-V9/article/view/12774

Molecular Pathogenesis of Gut Microbiome Associated Colorectal Cancer: Recent Updates | Chapter 10 | Socio-Scientific Interaction in Diabetes and Cancer and Its Management

 Background: Colorectal cancer (CRC) incidence and mortality vary distinctly around the world. It is the second most commonly diagnosed cancer in females and third in males while it ranked second in cancer-related deaths globally. Mutational landscape including chromosomal damage and microsatellite instability enabled to insignificant weightage about the survival of patients and their therapeutic response against CRC. Root cause of colorectal carcinogenesis has traditionally based on genetic alterations; however, in broader sense CRC advances as a result of complex communications between the microbiota, host mucosa, aberrant signaling, dietary components and inflammatory mediators. Additionally, it has increased risks combined with inflammatory bowel disease. Possible mechanism associated with CRC and microbial dysbiosis includes various bacterial signatures expose colonic mucosa via different metabolic and inflammatory stimuli, producing a proinflammatory state enabling DNA damage, aberrant signaling and ultimately CRC.

Objective: The objective of this study was to investigate the role of gut microbiota in CRC pathogenesis in light of recent updates.

Methods: PubMed and google scholar databases and carried out selective literature review on contribution of gut microbiota and associated mechanism in pathogenesis of CRC.

Results: Under normal conditions gut microbiome act as barrier to other pathogens or infection in gastrointestinal tract but studies suggest change in microbial composition related to CRC progression. Imbalance in microbial composition is related with inflammation induced tumorigenesis and modulation of anti-cancer immune response. Thus, gut microbiota can be used as biomarkers for early diagnosis and predict the effect of immunotherapy.

Conclusion: This review is focused on to dissect the role of intestinal microbiota and metabolites, signaling molecules and pro-inflammatory factors that directly or indirectly influencing the molecular carcinogenesis ultimately leading to CRC development. The recent updates will be benefited to many translational researchers as well as clinicians.

Author(s) Details:

Akansha Yadav,
Biochemistry and Molecular Biology Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India.

Rajendra Prakash Maurya,
Regional Institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Akhilendra Kumar Maurya,
Biochemistry and Molecular Biology Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India.

Please see the link here: https://stm.bookpi.org/SSIDCIM/article/view/12728

Dietary Natural Flavonoid Kaempferitrin Treats Colorectal Cancer by Targeting on the PI3K/AKT Signaling Pathway | Chapter 5 | Current Innovations in Disease and Health Research Vol. 3

 Colorectal tumor is the third most prevalent malignancy of all cancer types general, with an expected 2.4 lakhs occurrence by 2035. Flavonoids are a wide variety of polyphenols mainly found to have showed nutritional benefits. Kaempferitrin (Kaempferol-3,7-di-O-alpha-L-rhamnoside) is a glycosyloxyflavone that is kaempferol coupled to α-rhamnopyranosyl residues betwixt positions 3 and 7 respectively via glycosidic linkages. The microscopic formula C27H30O14 and has a molecular pressure of kaempferitrin 578.52 g/mol. Kaempferitrin a natural flavonoid has existed extracted from many edible plants that have stated anti-oxidant, anti-instigative, anti-diabetic, antagonistic-convulsant activities. Apoptosis induction, ROS result, and colorectal cancer (HT-29) container viability can all be inhibited by kaempferitrin in a aggregation-dependent manner. Additionally stimulating caspase-3 and increasing the percentages of cleaved PARP protein expression in HT-29 cells, kaempferitrin inferred caspase-dependent apoptosis. These kaempferitrin mediated apoptosis too exhibit a positive equivalence with the PI3/AKT pathway, suggesting that the HT-29 tumor cells may be point or direct at a goal downstream. Recent research has connected the PI3K/AKT pathway to the development of tumors and controls container death, distinction, and proliferation. Many malignancies, including colorectal malignancy, had a significant activation of the protein kinase B (PI3K/AKT) indicating pathway. Inhibiting the PI3K/AKT pathways again results in mitochondrial dysfunction, which produces ROS and kills cancer containers.

Author(s) Details:

Manju Vaiyapuri,
Department of Biochemistry, Periyar University, Salem – 636 011, India.

Lavanya Prathap,
Department of Anatomy, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai – 600077, India.

Mydhili Govindarasu ,
Department of Anatomy, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai – 600077, India.

Please see the link here: https://stm.bookpi.org/CIDHR-V3/article/view/11352

Intelligent Classification and Retrieval by the Interpretation of Image Features | Chapter 6 | New Advances in Medicine and Medical Science Vol. 8

 The happening of computer-aided disease has undergone a significant conversion from multiple aspects. In the past, it was only secondhand by radiology departments, but now it has extended to almost every dispassionate specialty's imaging practices. It influences dispassionate diagnosis by analyzing the connection between images and ailments, as well as their categorization and retrieval. Deep learning-located convolutional neural networks or vision transformers are more leading the development in this place field. This chapter introduces appropriate topics on image acknowledgment for colonoscopy and colorectal cancer, including the launch of several articles containing the early estimation of cancer by melanosis coli, the categorization of polyp, and the presentation utilizing content-based image recovery.

Author(s) Details:

Chung-Ming Lo,
National Chengchi University, Taiwan.

Please see the link here: https://stm.bookpi.org/NAMMS-V8/article/view/11074

Procalcitonin Level Recommendation as a Predictive Biomarker for Post-Operative Complication in Colorectal Cancer | Chapter 8 | New Advances in Medicine and Medical Science Vol. 6

 Although it can not be supported in after second hospitals, specifically in developing nations, C-sensitive protein (CRP) has been issued as a new biomarker parameter of post-active complications and has once been widely used in routine dispassionate practice. Early research found that when anticipating the post-operative depression following major gastrointestinal incision, the sensitivity and precision of the CRP level are better predictive indicators than the WBC level unique.During major gastrointestinal medical procedure (resection of colorectal malignancy), anastomosis leak was reported in 7 to 10% of cases. Clinical judgments in the early stages of anastomosis leak are frequently lacking to establish this difficulty and are occasionally incorrect as post-operative pain. Procalcitonin (PCT) is individual of the potential biomarkers that has been announced currently as a post-operative problem examination.

Author(s) Details:

Budhi Ida Bagus,
Department of Surgery, Sebelas Maret University, Indonesia.

Please see the link here: https://stm.bookpi.org/NAMMS-V6/article/view/10989

Increasing Trends, Late Presentation and Challenges of Colorectal Cancer in Uganda | Chapter 12 | Research Developments in Medicine and Medical Science Vol. 3

 Introduction: In Uganda, a flow towards an increased occurrence of colorectal cancer (CRC) has happened observed. According to the Kampala Cancer Registry, skilled has been a 4.1% annual allotment increase in the incidence of CRC between female patients. These cases present mainly accompanying late-stage disease accompanying resultant extreme morbidity and death. The aim of our study was to document the burden of CRC, late-stage performance and challenges associated with the increase CRC in Uganda.Methods: A cross-sectional study was completed activity between 2008 and 2021 on 404 subjects with histologically pronounced colorectal adenocarcinoma in central Uganda. Clinical records were inspected, and data were elicited for date of diagnosis, age, sexuality, location of the basic tumour, type of operation and TNM stage. Among 128 CRC subjects recruited and made inquiries, we obtained dossier on whether they had a colonoscopy and either there were colorectal adenomas.Results: The middle age was 54(43-67) years, accompanying 38.9% being ≤ 49 years adult. The male: female sex percentage was 1:1, and advanced-stage ailment constituted 217(60.8%) CRC cases. In all age groups, the repetitiveness of CRC increased from 17 cases in 2008 to 61 cases in 2021. Out of the 128 colleagues who were made inquiries prospectively, only 56(43.8%) had a colonoscopy, among whom 5(8.9%) CRC inmates had colorectal adenomas. Having a family history of CRC (OR=19.83, 95% CI: 2.56-153.74, p=0.004) and GI cancers (OR=6.79, 95% CI, 1.02-45.08, p=0.047) were guide having colorectal adenomatous polyps. Rectal tumours were ultimate common tumours 212(53%), inasmuch as the most common movement performed was a reduced anterior redistribute among these CRC cases 81(30%).Conclusions: The increase in the CRC burden in Uganda should should a public health preference. Increasing the endoscopic and surgical infrastructure to develop the ability to screen, pinpoint and manage CRC is main to improve melancholy and mortality. The extreme number of young individuals pinpointed with CRC is of concern. Therefore, age-appropriate domestic screening directions and education campaigns are unavoidable for Uganda to manage the growing burden of CRC.

Author(s) Details:

Richard Wismayer,
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Julius Kiwanuka,
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Henry Wabinga,
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Michael Odida,
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

Please see the link here: https://stm.bookpi.org/RDMMS-V3/article/view/9923

Dietary Risk Factors for Colorectal Cancer in an Indigenous East African Population| Chapter 4 | Perspective of Recent Advances in Medical Research Vol. 2

 Introduction: Low-proceeds countries in East Africa have a lower occurrence of colorectal cancer (CRC) than well-paid countries; however, the occurrence has steadily raised in the last few decades. In East Africa, the extent at which point genetic and incidental factors, particularly digestive factors, help the aetiology of CRC is unclear. Therefore, the objective of our study search out determine the connection between abstinence from food factors and CRC in an indigenous populace in East Africa.Methods: We conducted a case-control study and inducted 128 cases and 256 controls, block matched for age (±5 age) and sex. Data concerning diet were obtained from all the participants utilizing an interview-based inquiry. The potential dietary risk determinants and protective determinants evaluated contained the type, frequency of meat exhausted and the type and frequency of fibre snacks consumed. The commonness was either 4x and above/week or 2-3x/period or 1x/week or never. Ordinal and dependent logistic regression analyses were used to decide the odds percentages associated with the various risk and protective determinants.Results: The mean age (SD) was 53.5(16.2) years and the male:female ratio was 1:1 for all the shareholders. The most significant risk determinants included devouring of boiled beef 2-3x/temporal length of event or entity's existence (aOR:1.63; p<0.001) and consumption of deep-fried chicken 2-3x/week (aOR: 2.60; p=0.027). Consumption of extreme fibre foods, containing:- cassava for ≥4x/week (aOR: 0.40; p=0.016), millet for 1x/period (aOR: 0.49; p=0.034) and for ≥4x/week (aOR:0.32; p=0.001), undetailed lie for ≥4x/week (aOR:0.30; p=0.003), and potatoes 2-3x/period (aOR: 0.44; p=0.041), were protective against CRC.Conclusions: The use of cooked core increases the risk of CRC, while the intake of extreme-fibre foods grant permission reduce the risk of CRC among Ugandans. We approve nutritional instructional programmes to increase public awareness concerning the protective part of a high fibre diet and to limit the intake of barbecued meat in our native East African population.

Author(s) Details:

Richard Wismayer,
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda and Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Julius Kiwanuka,
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Henry Wabinga,
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Michael Odida,
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

Please see the link here: https://stm.bookpi.org/PRAMR-V2/article/view/9013

Modern Pharmaceutical Technologies for Drug Targeting: A Review on Colon Specific Drug Delivery Systems | Chapter 12 | Challenges and Advances in Pharmaceutical Research Vol. 4

The purpose of the current study is to emphasise the value of contemporary pharmacological techniques for successfully delivering drugs to the targeted site of action by directing them to the colonic area. Due to its potential pharmacological advantages, colon drug targeting has been the subject of much study and development over the past few decades. On the other hand, colon delivery systems have demonstrated their promise as drug carriers for the treatment of many illnesses. They decrease side effects, protect drugs from attacks by the acidic and alkaline medium of the upper GI tract, avoid dosage dumping, etc. The article outlines many technologies or tactics that have been investigated for colon targeting, including time-dependent systems, For prospective pharmaceutical therapeutic applications, consider intestinal pressure-controlled colon delivery capsules, CODESTM technology, pH-dependent systems, enzyme-triggered systems, receptor-mediated systems, etc.

Author (s) Details:

Reena Kaushik,
Department of Pharmacy, Guru Ghasidas Vishwavidyalaya, Bilaspur (C.G.) - 495009, Chhattisgarh, India.

S. K. Lanjhiyana,
Department of Pharmacy, Guru Ghasidas Vishwavidyalaya, Bilaspur (C.G.) - 495009, Chhattisgarh, India.

Sanmati K. Jain,
Department of Pharmacy, Guru Ghasidas Vishwavidyalaya, Bilaspur (C.G.) - 495009, Chhattisgarh, India.

Sweety Lanjhiyana,
School of Pharmacy, Chouksey Engineering College, Bilaspur (C.G.) - 495001, Chhattisgarh, India.

A. C. Rana,
Institute of Pharmaceutical Sciences, Kurukshetra University, Kurukshetra-136119, Haryana, India.

Please see the link here: https://stm.bookpi.org/CAPR-V4/article/view/7521