Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 53
Filtrar
1.
World J Surg ; 48(8): 1990-1999, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38844401

RESUMO

BACKGROUND: Prior studies focus primarily on surgical outcomes of anal fistula treatment, such as healing rates, rather than patient-reported outcomes, such as postoperative pain, which could influence surgical choice. OBJECTIVE: To compare pain scores at 6 and 24 h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula. DESIGN: Prospective, double-blinded randomized controlled trial. SETTINGS: A quaternary hospital in Malaysia. PATIENTS: Patients aged 18-75 years with high transsphincteric fistulas. INTERVENTION: Fistula laser closure versus ligation of the fistula tract (LIFT) treatment. MAIN OUTCOME MEASURES: Pain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi-square, Fisher's exact test, student t-test, or Mann-Whitney with p < 0.05 denoting statistical significance. RESULTS: Fifty-six patients were recruited (laser, n = 28, LIFT, n = 28). Median pain scores for laser versus LIFT at 6 h postoperatively were 1.0 versus 2.0 (Rest, p = 0.213) and 3.0 versus 4.0 (Movement, p = 0.448), respectively. At 24 h, this reduced to 2.5 in both arms at rest (p = 0.842) but increased to 4.8 versus 3.5 on movement (p = 0.383). Median operative time for laser was significantly shorter (32.5 min) than LIFT (p < 0.001). Laser treated patients trended toward quicker return to work (10.5 vs. 14.0, p = 0.181) but treatment failure was similar (54% vs. 50%, p = 0.71). No patients developed postoperative incontinence. Mean SF-36 scores increased from baseline (67.1 ± 17.0; 95% CI 63.6-82.4 vs. 71.3 ± 11.4; 95% CI 64.0-75.0) to 6 months postoperatively (77.7 ± 21.0; 95% CI 57.0-80.3 vs. 74.0 ± 14.3; 95% CI 67.6-81.4) regardless of the type of surgery (P > 0.05). LIMITATIONS: Patients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy. CONCLUSION: Laser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06212739.


Assuntos
Terapia a Laser , Dor Pós-Operatória , Fístula Retal , Humanos , Pessoa de Meia-Idade , Adulto , Método Duplo-Cego , Masculino , Feminino , Estudos Prospectivos , Dor Pós-Operatória/etiologia , Fístula Retal/cirurgia , Terapia a Laser/métodos , Idoso , Ligadura/métodos , Adolescente , Adulto Jovem , Medição da Dor , Resultado do Tratamento , Qualidade de Vida
2.
Lasers Med Sci ; 37(8): 3291-3296, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36044123

RESUMO

BACKGROUND: Several studies have investigated the role of laser ablation of anal fistulae in the European setting. However, long-term follow-up results following laser fistula ablations are not widely investigated and no study was performed in the Asia-Pacific, a region with a distinctive prevalence of tuberculosis. The primary objective of this study is to report a single-centre experience with laser ablation of anal fistulae in Malaysia over a period of 6 years. METHOD: This was a retrospective observational study assessing the outcomes following 70 laser ablations of anal fistulae from February 2014 till December 2019. All cases were assessed using endoanal ultrasound. The laser ablation procedures were performed using laser systems and fibres from Endoteq Medizinische Laser GmBH, Germany, and Biolitec AG, Jena, Germany. Laser fibres were introduced into the fistula tract and laser energy was emitted radially in continuous mode when activated during the procedure. Pre-defined post-procedural outcomes (primary healing, healing failure or recurrence) were recorded as either present or absent during subsequent follow-up appointments and the data was analysed. RESULTS: Over a median follow-up period of 10 months, primary healing was reported following 42 procedures (60.0%). Healing failure was reported following 28 procedures (40.0%) whilst recurrence was seen after 16 procedures (22.86%). No new cases of incontinence were reported following the procedure. CONCLUSION: The reported primary healing rate following laser ablation of anal fistulae in this study appears consistent with existing literature published by other international centres. The most apparent clinical advantage of this procedure is sphincter-function preservation. However, the primary healing rate after isolated laser fistula ablation is still suboptimal. Judicious patient selection and application in anal fistulae with suitable characteristics could potentially improve the post-procedural outcomes.


Assuntos
Terapia a Laser , Fístula Retal , Canal Anal/cirurgia , Hospitais de Ensino , Humanos , Terapia a Laser/métodos , Malásia/epidemiologia , Fístula Retal/cirurgia , Recidiva , Resultado do Tratamento
3.
BMC Surg ; 22(1): 146, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449097

RESUMO

INTRODUCTION: The effectiveness of hemorrhoidal artery ligation supplementation in reducing the incidence of post laser hemorrhoidoplasty bleeding has not been investigated. METHODS: This was a double-blind, randomized controlled trial comparing post-operative bleeding incidence in patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL). Outcome measures included post-operative bleeding and its severity (i.e. verbal rating scale and Clavien-Dindo classification), presence of perianal swelling and pain score (visual analog score) at 1-day, 1-week and 6-weeks post-operatively. Statistical tests were performed and a value of P < 0.05 was considered significant. RESULTS: Seventy-six patients were randomized. There was no difference in median operating time. The bleeding incidence was highest at 1-week post-operatively (17.1%), and decreased to 1.3% at 6-weeks. There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P > 0.05). Severity of bleeding and incidence of post-operative perianal swelling were similar in both groups (P > 0.05). There was no difference in median pain scores. CONCLUSION: Supplementation of HAL to LHP does not reduce the post-operative bleeding incidence. LHP is sufficient as a stand-alone procedure for treating haemorrhoids. TRIAL REGISTRATION: National Registration Number is NMRR-15-1112-24065 (IIR). The trial start date was 1st January 2015 with the ClinicalTrials.gov identifier and registration number as NCT04667169.


Assuntos
Hemorroidas , Artérias/cirurgia , Hemorroidas/cirurgia , Humanos , Incidência , Lasers , Ligadura , Dor , Dor Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória , Resultado do Tratamento
4.
Clin Colon Rectal Surg ; 35(5): 371-375, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36111081

RESUMO

Global surgery is a burgeoning area of global health. Surgeons can engage in one-or many-of the facets of global healthcare delivery: clinical care, capacity building, education, research, etc. Working in an increasingly global community, surgeons must be aware of the richness of cultural diversity at home and around the world such that they can provide culturally sensitive care. This chapter focuses on the most common way in which surgeons engage in global surgery: surgical short-term experiences in global health (STEGHs). Surgical STEGHs pose an intricate set of ethical dilemmas. As team leaders, surgeons must understand the community they intend to serve on these trips. Further, they should confirm that everyone who joins them is prepared to deliver care in a culturally sensitive and competent manner. Finally, surgeons must consider potential ethical dilemmas that may arise before, during, and after surgical STEGHs and have strategies to navigate them.

6.
Malays J Med Sci ; 26(1): 15-43, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30914891

RESUMO

The World Health Organization estimates that annually 150 million people experience severe (catastrophic) financial difficulties as a result of healthcare payments. Therefore, a systematic review was carried out to identify the determinants of household catastrophic health expenditure (CHE) in low-to high-income countries around the world. Both electronic and manual searches were conducted. The main outcome of interest was the determinants of CHE due to healthcare payments. Thirty eight studies met the inclusion criteria for review. The analysis revealed that household economic status, incidence of hospitalisation, presence of an elderly or disabled household member in the family, and presence of a family member with a chronic illness were the common significant factors associated with household CHE. The crucial finding of the current study is that socioeconomic inequality plays an important role in the incidence of CHE all over the world, where low-income households are at high risk of financial hardship from healthcare payments. This suggests that healthcare financing policies should be revised in order to narrow the gap in socioeconomic inequality and social safety nets should be implemented and strengthened for people who have a high need for health care.

7.
Malays J Med Sci ; 26(1): 73-86, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30914895

RESUMO

BACKGROUND: The incidence of colorectal cancer (CRC) is rapidly rising in several Asian countries, including Malaysia, but there is little data on health care provider costs in this region. The aim of this study was to estimate the cost of CRC management from the perspective of the health care provider, based on standard operating procedures. METHODS: A combination of top-down approach and activity-based costing was applied. The standard operating procedure (SOP) for CRC was developed for each stage according to national data and guidelines at the University of Malaya Medical Centre (UMMC). The unit cost was calculated and incorporated into the treatment pathway in order to obtain the total cost of managing a single CRC patient according to the stage of illness. The cost data were represented by means and standard deviation and the results were demonstrated by tabulation. All cost data are presented in Malaysian Ringgit (RM). The cost difference between early stage (Stage I) and late stage (Stage II-IV) was analysed using independent t-test. RESULTS: The cost per patient increased with stage of CRC, from RM13,672 (USD4,410.30) for stage I, to RM27,972 (USD9,023.20) for Stage IV. The early stage had statistically significant lower cost compared to late stage t(2) = -4.729, P = 0.042. The highest fraction of the cost was related to surgery for Stage I, but was superseded by oncology day care treatment for Stages II-IV. CRC is a costly illness. From a provider perspective, the highest cost was found in Stages III and IV. The early stages conserved more resources than did the advanced stages of cancer. CONCLUSION: Early diagnosis and management of CRC, therefore, not only affects oncologic prognosis, but has implications for health care costs. This adds further justification to develop and implement CRC screening programmes in Malaysia.

8.
BMC Cancer ; 17(1): 339, 2017 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-28521746

RESUMO

BACKGROUND: Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. It is the second most common cancer among both males and females in Malaysia. The economic burden of colorectal cancer is likely to increase over time owing to its current trend and aging population. Cancer survival analysis is an essential indicator for early detection and improvement in cancer treatment. However, there was a scarcity of studies concerning survival of colorectal cancer patients as well as its predictors. Therefore, we aimed to determine the 1-, 3- and 5-year survival rates, compare survival rates among ethnic groups and determine the predictors of survival among colorectal cancer patients. METHODS: This was an ambidirectional cohort study conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia. All Malaysian citizens or permanent residents with histologically confirmed diagnosis of colorectal cancer seen at UMMC from 1 January 2001 to 31 December 2010 were included in the study. Demographic and clinical characteristics were extracted from the medical records. Patients were followed-up until death or censored at the end of the study (31st December 2010). Censored patients' vital status (whether alive or dead) were cross checked with the National Registration Department. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Log-rank test was used to compare the survival rates, while Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival. RESULTS: Among 1212 patients, the median survival for colorectal, colon and rectal cancers were 42.0, 42.0 and 41.0 months respectively; while the 1-, 3-, and 5-year relative survival rates ranged from 73.8 to 76.0%, 52.1 to 53.7% and 40.4 to 45.4% respectively. The Chinese patients had the lowest 5-year survival compared to Malay and Indian patients. Based on the 814 patients with data on their Duke's staging, independent predictors of poor colorectal cancer (5-year) survival were male sex (Hazard Ratio [HR]: 1.41; 95% CI: 1.12, 1.76), Chinese ethnicity (HR: 1.41; 95% CI: 1.07,1.85), elevated (≥ 5.1 ng/ml) pre-operative carcino-embryonic antigen (CEA) level (HR: 2.13; 95% CI: 1.60, 2.83), Duke's stage C (HR: 1.68; 95% CI: 1.28, 2.21), Duke's stage D (HR: 4.61; 95% CI: 3.39, 6.28) and emergency surgery (HR: 1.52; 95% CI: 1.07, 2.15). CONCLUSIONS: The survival rates of colorectal cancer among our patients were comparable with those of some Asian countries but lower than those found in more developed countries. Males and patients from the Chinese ethnic group had lower survival rates compared to their counterparts. More advanced staging and late presentation were important predictors of colorectal cancer survival. Health education programs targeting high risk groups and emphasizing the importance of screening and early diagnosis, as well as the recognition of symptoms and risk factors should be implemented. A nationwide colorectal cancer screening program should be designed and implemented to increase early detection and improve survival outcomes.


Assuntos
Neoplasias Colorretais/mortalidade , Adulto , Idoso , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento
10.
Proc Natl Acad Sci U S A ; 111(51): 18321-6, 2014 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-25489084

RESUMO

Environmental factors clearly affect colorectal cancer (CRC) incidence, but the mechanisms through which these factors function are unknown. One prime candidate is an altered colonic microbiota. Here we show that the mucosal microbiota organization is a critical factor associated with a subset of CRC. We identified invasive polymicrobial bacterial biofilms (bacterial aggregates), structures previously associated with nonmalignant intestinal pathology, nearly universally (89%) on right-sided tumors (13 of 15 CRCs, 4 of 4 adenomas) but on only 12% of left-sided tumors (2 of 15 CRCs, 0 of 2 adenomas). Surprisingly, patients with biofilm-positive tumors, whether cancers or adenomas, all had biofilms on their tumor-free mucosa far distant from their tumors. Bacterial biofilms were associated with diminished colonic epithelial cell E-cadherin and enhanced epithelial cell IL-6 and Stat3 activation, as well as increased crypt epithelial cell proliferation in normal colon mucosa. High-throughput sequencing revealed no consistent bacterial genus associated with tumors, regardless of biofilm status. However, principal coordinates analysis revealed that biofilm communities on paired normal mucosa, distant from the tumor itself, cluster with tumor microbiomes as opposed to biofilm-negative normal mucosa bacterial communities also from the tumor host. Colon mucosal biofilm detection may predict increased risk for development of sporadic CRC.


Assuntos
Neoplasias Colorretais/microbiologia , Microbiota , Bactérias/classificação , Bactérias/isolamento & purificação , Biofilmes , Colonoscopia , Humanos
12.
Support Care Cancer ; 24(10): 4423-32, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27225528

RESUMO

BACKGROUND: In Malaysia, the healthcare system consists of a government-run universal healthcare system and a co-existing private healthcare system. However, with high and ever rising healthcare spending on cancer management, cancer patients and their families are likely to become vulnerable to a healthcare-related financial burden. Moreover, they may have to reduce their working hours and lose income. To better understand this issue, this study aims to assess the financial burden of colorectal cancer patients and their families in the first year following diagnosis. METHODS: Data on patient costs were collected prospectively in the first year following diagnosis by using a self-administered questionnaire and telephone interviews at three time points for all four stages of colorectal cancer. The patient cost data consisted of direct out-of-pocket payments for medical-related expenses such as hospital stays, tests and treatment and for non-medical items such as travel and food associated with hospital visits. In addition, indirect cost data related to the loss of productivity of the patient and caregiver(s) was assessed. The patient's perceived level of financial difficulty and types of coping strategy were also explored. RESULT: The total 1-year patient cost (both direct and indirect) increased with the stage of colorectal cancer: RM 6544.5 (USD 2045.1) for stage I, RM 7790.1 (USD 2434.4) for stage II, RM 8799.1 (USD 2749.7) for stage III and RM 8638.2 (USD 2699.4) for stage IV. The majority of patients perceived paying for their healthcare as somewhat difficult. The most frequently used financial coping strategy was a combination of current income and savings. CONCLUSION: Despite the high subsidisation in public hospitals, the management of colorectal cancer imposes a substantial financial burden on patients and their families. Moreover, the majority of patients and their families perceive healthcare payments as difficult. Therefore, it is recommended that policy- and decision-makers should further consider some financial protection strategies and support for cancer treatment because cancer is a very costly and chronic disease.


Assuntos
Neoplasias Colorretais/economia , Gastos em Saúde/estatística & dados numéricos , Neoplasias Colorretais/terapia , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Classe Social , Inquéritos e Questionários
13.
World J Surg ; 40(8): 1985-92, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27098538

RESUMO

INTRODUCTION: Disruption of normal gut function is a common side effect post abdominal surgery. It may result in reduced tolerance to oral nutrition and progress to postoperative ileus. Microbial cell preparation is beneficial as a pre-surgical nutritional supplement to aid in bowel recovery and promote the return of normal gut function following abdominal surgery. The aim of this study was to evaluate the efficacy of pre-surgical administration of microbial cell preparation in promoting the return of normal gut function. METHOD: The study is a randomized, double-blind, placebo-controlled trial. In total, 40 patients were recruited. Patients were randomized to receive either microbial cell preparation (n = 20) or placebo (n = 20) for 7 days prior to elective surgery. The primary end point was the time to return of normal gut function, while the secondary end point was the duration of hospital stay. RESULTS: The treatment group demonstrated significantly faster return of normal gut function with a median of 108.5 h (80-250 h) which was 48 h earlier than the placebo group at a median of 156.5 h (94-220 h), p = 0.022. The duration of hospital stay in the treatment group was also shorter at a median of 6.5 days (4-30 days), in comparison to the placebo group at 13 days (5-25 days), p = 0.012. CONCLUSION: Pre-surgical administration of microbial cell preparation promotes the return of normal gut function in patients after colorectal cancer surgery, thus associated with faster recovery and shorter duration of hospital stay.


Assuntos
Neoplasias Colorretais/cirurgia , Cuidados Pré-Operatórios , Probióticos/uso terapêutico , Idoso , Método Duplo-Cego , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recuperação de Função Fisiológica
15.
Support Care Cancer ; 23(3): 889-98, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25337681

RESUMO

PURPOSE: The escalating health-care spending for cancer management has caused cancer patients to struggle further as a result of financial burden. This systematic review was carried out to investigate the prevalence of perceived financial hardship and associated factors among cancer patients and their families. METHODS: A systematic search for studies concerning the perception of financial burden among cancer patients and their families was conducted. Several electronic resources such as Medline, Elsevier (Science Direct), Web of Science, Embase, PubMed, CINAHL and Scopus (SciVerse) were searched. Additionally, manual search through indices citation was also thoroughly utilized. The main outcome of interest was the prevalence of perceived financial hardship among cancer patients and their families. Studies reported only the cost of cancer treatment and qualitative studies were excluded. Our search was limited to articles that were published from 2003 to 2013. RESULT: Ten studies were included in this review and with a majority originating from high-income countries. The prevalence of the financial burden perception was reported between 14.8 and 78.8 %. The most frequent and significant risk factor reported associated with the perception of financial difficulty was the households with low income. Discontinuation of treatment and poverty were conversely the important consequences of financial burden in cancer patients and their families. CONCLUSION: Evidently, cancer is a long-term illness that requires a high financial cost, and a significant number of cancer patients and families struggle with financial difficulty. Identifying such groups with a high risk of facing financial difficulty is a crucial measure to ensure safety nets are readily available for these targeted population.


Assuntos
Efeitos Psicossociais da Doença , Neoplasias/economia , Percepção , Adulto , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Atenção à Saúde/economia , Família/psicologia , Feminino , Humanos , Renda , Neoplasias/epidemiologia , Pobreza
16.
BMC Gastroenterol ; 14: 95, 2014 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-24885285

RESUMO

BACKGROUND: Prevalence data is essential for planning of healthcare services. The prevalence of faecal incontinence (FI) varies worldwide, and in Malaysia is not known. We sought to estimate its prevalence among patients with various conditions in a Malaysian academic setting. METHOD: A questionnaire-based survey was conducted among a convenience sample of adult patients and relatives who visited the Obstetrics and Gynaecology and General Surgery Clinics of University of Malaya Medical Centre (UMMC) from June 2009 to February 2010. Data collected included patient demographics and pre-existing medical conditions known to be FI risk factors. Severity of FI was assessed using the Wexner Continence Scale (WCS). RESULTS: Among the 1000 subjects recruited into the study, 760 (76%) were female and the median age was 38 years with an inter-quartile range of 24 years. The prevalence of FI among the study subjects was found to be 8.3%. Among them, 63 subjects (75.9%) were determined to have mild FI as measured by the WCS. The proportions of patients with moderate and severe FI were 18.3% and 6.0%, respectively. FI was found to be significantly associated with older age, presence of diabetes mellitus and increased duration of defaecation. There was no statistically significant association between FI and sex, defaecation frequency, or history of surgery. CONCLUSION: FI in our setting is prevalent enough to warrant targeted healthcare interventions, including the need to improve general public awareness of the condition in order to counter social stigma and embarrassment that may be faced by patients.


Assuntos
Povo Asiático , Diabetes Mellitus/epidemiologia , Incontinência Fecal/epidemiologia , População Branca , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Incontinência Fecal/etnologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
17.
J Gastroenterol Hepatol ; 29(11): 1890-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24909623

RESUMO

BACKGROUND AND AIM: With an increasing burden on overstretched colonoscopy services, a simple risk score for significant pathology in symptomatic patients may aid in the prioritization of patients. METHODS: A derivative study of a risk score model for colonic neoplasia (colorectal carcinoma [CRC] and advanced adenoma) and CRC alone was conducted in symptomatic adults referred for an index colonoscopy. The accuracy of the final model was assessed by the area under the curve (AUC) of the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit statistic. RESULTS: A total of 1013 subjects (mean age 59.9 ± 13.7 years, 52.3% females) from a multi-ethnic Asian background (Chinese 56%, Malay 20.4%, Indian 21.5%) were recruited. Colonic neoplasia and CRC were identified in 175 (17.3%) and 114 (11.3%) cases, respectively. Risk scores were assigned to individual factors identified in a logistic regression model of both demographic (age, gender, ethnicity, education level, smoking history, Aspirin use) and clinical symptoms (change in bowel habit, bloody stool, weight loss, appetite loss, lethargy). The risk score for each patient was the sum of their individual risk factors. The AUC of the risk score for colonic neoplasia and CRC was 0.76 (Hosmer-Lemeshow goodness-of-fit statistic of P = 0.745) and 0.83 (Hosmer-Lemeshow goodness-of-fit statistic of P = 0.982), respectively. CONCLUSION: A simple risk score for colonic neoplasia and CRC may be able to prioritize colonoscopy referrals in symptomatic subjects from a multi-ethnic background. A further study to validate this scoring system is required.


Assuntos
Adenoma/diagnóstico , Carcinoma/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adenoma/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Carcinoma/epidemiologia , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Prevalência , Curva ROC , Risco , Fatores de Risco , Adulto Jovem
18.
Int J Mol Sci ; 15(7): 11713-29, 2014 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-24992592

RESUMO

Recent advances in microRNAome have made microRNAs (miRNAs) a compelling novel class of biomarker in cancer biology. In the present study, the role of miR-23a in the carcinogenesis of colorectal cancer (CRC) was investigated. Cell viability, apoptosis, and caspase 3/7 activation analyses were conducted to determine the potentiality of apoptosis resistance function of miR-23a in CRC. Luciferase assay was performed to verify a putative target site of miR-23a in the 3'-UTR of apoptosis protease activating factor 1 (APAF1) mRNA. The expression levels of miR-23a and APAF1 in CRC cell lines (SW480 and SW620) and clinical samples were assessed using reverse transcription-quantitative real-time PCR (RT-qPCR) and Western blot. We found that the inhibition of miR-23a in SW480 and SW620 cell lines resulted in significant reduction of cell viability and promotion of cell apoptosis. Moreover, miR-23a up-regulation was coupled with APAF1 down-regulation in CRC tissue samples. Taken together, miR-23a was identified to regulate apoptosis in CRC. Our study highlights the potential application of miR-23a/APAF1 regulation axis in miRNA-based therapy and prognostication.


Assuntos
Apoptose , Fator Apoptótico 1 Ativador de Proteases/metabolismo , Neoplasias Colorretais/metabolismo , MicroRNAs/metabolismo , Regiões 3' não Traduzidas , Idoso , Fator Apoptótico 1 Ativador de Proteases/genética , Estudos de Casos e Controles , Caspase 3/genética , Caspase 3/metabolismo , Caspase 7/genética , Caspase 7/metabolismo , Linhagem Celular Tumoral , Feminino , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
19.
Microorganisms ; 11(2)2023 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-36838407

RESUMO

Klebsiella pneumoniae (K. pneumoniae) colonizes the human gut and is a causative factor of pyogenic liver abscess (PLA). Retrospective studies conducted on K. pneumoniae PLA patients revealed subsequent CRC development in later years of their life with increasing prevalence of these strains harbouring polyketide synthase (PKS) genes. To our knowledge there are no known studies directly implicating K. pneumoniae with CRC to date. Our aims are to characterize K. pneumoniae isolates from CRC patients and investigate its effects on cell proliferation in vitro. K. pneumoniae isolates were characterized by screening virulence genes including polyketide synthase (PKS), biofilm assay, antibiotic susceptibility, and string test to determine hypervirulent (hvKp) strains. Solubilised antigens of selected K. pneumoniae isolates were co-cultured with primary colon cell lines and CRC cell lines (Stage I-IV) for 48 h. The enhancement of proliferation was measured through MTT and ECIS assay. Twenty-five percent of K. pneumoniae isolates were PKS-positive out of which 50% were hvKp strains. The majority of the isolates were from the more virulent serotype of K1 (30%) and K2 (50%). PKS-positive K. pneumoniae isolates did not possess genes to confer carbapenem resistance but instead were more highly associated with siderophore genes (aerobactin, enterobactin, and yersiniabactin) and allantoin metabolism genes (allS, allS2). Cell proliferation in primary colon, SW1116 (Stage I), and SW480 (Stage II) CRC cell lines were enhanced when co-cultured with PKS-positive K. pneumoniae antigens. ECIS revealed enhanced cell proliferation upon recurrent antigen exposure. This demonstrates the possible role that PKS-positive K. pneumoniae has in exacerbating CRC progression.

20.
Adv Ther ; 40(1): 117-132, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36331754

RESUMO

INTRODUCTION: Hemorrhoidal disease (HD) is characterized by prolapse of the inflamed and bleeding vascular tissues of the anal canal. Although HD is associated with a high recurrence rate, there is a lack of understanding around interventions that can reduce recurrence and improve outcomes for patients. As such, a systematic literature review (SLR) was conducted to summarize evidence on epidemiology, recurrence, and efficacy of interventions in HD. METHODS: Real-world evidence (RWE) studies evaluating the incidence, prevalence, or recurrence of HD, as well as SLRs including a meta-analytic component reporting on the efficacy of systemic or topical pharmacological treatments for adults with HD, were included. Systematic searches were conducted in MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews. RESULTS: The SLR identified 44 eligible publications. Consistent data were limited on the epidemiology of HD or HD recurrence. Specifically, incidence and prevalence reported across geographies were impacted by differences in data collection. Reported risk factors for HD were sedentary behavior, constipation, male gender, and age. Twenty-three RWE studies and one meta-analysis reported HD recurrence rates ranging from 0 to 56.5% following surgery or phlebotonics, with most (n = 19) reporting rates of 20% or less. In addition to time since treatment, risk factors for recurring disease were similar to those for HD in general. With respect to treatment, micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments. CONCLUSION: The SLRs did not identify any RWE studies reporting recurrence in patients receiving systemic or topical treatments, highlighting the need for future research in this area. Further, more studies are needed to understand the optimum duration of medical treatment to prevent recurrence.


Patients with hemorrhoidal disease (HD) can experience recurring disease following a period of improvement or remission. It is not well established how often this might happen, who is at greatest risk, or which treatments can reduce this risk. In this study, a systematic literature review (SLR) was conducted to summarize evidence on the occurrence and recurrence of HD, as well as treatment effectiveness. Several literature databases were searched for articles that described real-world evidence (RWE) studies reporting the epidemiology or recurrence of HD as well as published SLRs that combined the results of multiple studies (meta-analyses) on treatment for adults with HD. Forty of 2037 articles identified by the search were considered relevant, and four others identified by clinicians were also included (total = 44; 39 RWE, 5 meta-analyses). Review of the RWE articles revealed that HD epidemiology was determined differently between studies. Only 23 reported recurrence rates (up to 56.5%) after surgery or treatment with phlebotonic drugs (drugs that improve blood flow in veins). Most (19/23) reported recurrence rates of 20% or less. Risk factors for recurrence were similar to usual HD risk factors (e.g., constipation, male gender, age) in addition to time since treatment. Phlebotonic agents, including those made from plant extracts (micronized purified flavonoid fractions, MPFFs) improved hemorrhoidal symptoms compared with placebo or no treatment. In one meta-analysis, MPFF was the only phlebotonic to significantly reduce recurrence risk versus no treatment or placebo. Overall, more research is needed to compare treatments and determine optimal treatment duration to prevent recurrence. Author-narrated video abstract.


Assuntos
Hemorroidas , Adulto , Humanos , Masculino , Flavonoides , Hemorragia , Hemorroidas/tratamento farmacológico , Hemorroidas/epidemiologia , Fatores de Risco , Metanálise como Assunto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA