Validation of the Malaysian Chinese-version of the EORTC QLQ-CR29 among Colorectal cancer patients in Malaysia

Patient reported outcome research are becoming a very important way of understanding patient’s satisfaction and tolerance with the treatment they receive. This study examined the validity and reliability of the Malaysian Chinese version of the European Organization for Research and Treatment of Cancer (EORTC) colorectal cancer-specific quality of life questionnaire (QLQ-CR29). Patients were recruited at the outpatient clinics of the University of Malaya and Universiti Kebangsaan Medical Centre, Malaysia. The QLQ-CR29 and Karnofsky Performance Scales (KPS) were used. Multi-traits scaling analysis such as Cronbach’s alpha, inter-class correlation (ICC) and known-groups comparisons (Wilcoxon-rank sum test) were performed. Significant level was pre-set at ≤ 0.05. Patients mean age (standard deviation, SD) was 64 (10) years, and 60% were male. Colon cancer was 50%. While 60% had advanced stage (Dukes’ C/D) cancers and about 30% of patients had a stoma. The mean KPS was 80% (SD 10). The internal consistency coefficient (ICC) was 0.89, 0.84, 0.46, and 0.73 for body image, urinary frequency, blood & mucus in stool and stool frequency scales respectively. The correlation coefficients for convergent validity were moderate to large (r ranged from 0.72 to 0.93) across all scales. For the discriminant validity measurements, small to moderate correlations were observed across the scales. The psychometric properties of the Malaysian Chinese version of the QLQ-CR29 were comparable to the original English version. This work provides a translated, culturally adapted, reliable and valid measure of HRQOL for use among Malaysian Chinese patients with colorectal cancer

Molecular Signatures of Human Regulatory T Cells in Colorectal Cancer and Polyps

Regulatory T cells (Tregs), a subset of CD4+ or CD8+ T cells, play a pivotal role in regulating immune homeostasis. An increase in Tregs was reported in many tumors to be associated with immune suppression and evasion in cancer patients. Despite the importance of Tregs, the molecular signatures that contributed to their pathophysiological relevance remain poorly understood and controversial. In this study, we explored the gene expression profiles in Tregs derived from patients with colorectal cancer [colorectal carcinoma (CRC), n = 15], colorectal polyps (P, n = 15), and in healthy volunteers (N, n = 15). Tregs were analyzed using CD4+CD25+CD127lowFoxP3+ antibody markers. Gene expression profiling analysis leads to the identification of 61 and 66 immune-related genes in Tregs derived from CRC and P patients, respectively, but not in N-derived Treg samples. Of these, 30 genes were differentially expressed both in CRC- and P-derived Tregs when compared to N-derived Tregs. Most of the identified genes were involved in cytokine/chemokine mediators of inflammation, chemokine receptor, lymphocyte activation, and T cell receptor (TCR) signaling pathways. This study highlights some of the molecular signatures that may affect Tregs’ expansion and possible suppression of function in cancer development. Our findings may provide a better understanding of the immunomodulatory nature of Tregs and could, therefore, open up new avenues in immunotherapy

Giant Inflammatory Polyposis of the Rectum as a Complication of Ulcerative Colitis

Inflammatory bowel disease is an emerging gastrointestinal disease in Malaysia. One of its rare complications includes giant inflammatory polyposis (GIP). A 39-year-old woman presented with worsening per rectal mucous discharge, associated with blood, colicky abdominal pain, and weight loss. A series of endoscopies at another hospital did not provide an inconclusive diagnosis. Another repeat colonoscopy showed a left-sided colitis with marked erythema and friability with islands of polyps; this was concluded to be an ulcerative colitis based on histopathology; thus, medical treatment was commenced. However, 2 months later, the patient presented with constipation, which required laxatives, as well as a worsened lower abdominal pain. Subsequent colonoscopy revealed obstruction-caused GIP at the mid rectum extending to the lower rectum, which was confirmed by imaging modalities. She was diagnosed with obstructing GIP coupled with ulcerative colitis, and panproctocolectomy and ileal pouch anal anastomosis were planned

The dilemma in management of desmoid tumour: A case report

Introduction: Desmoid tumours are rare benign tumours. The tumours may develop sporadically or they may be linked to familial adenomatous polyposis (FAP) in Gardner’s syndrome. Aim: This article highlights a young lady with an intra-abdominal desmoid tumour that manifested as an acute abdomen and we discuss our management strategy. Case study: A 24-year-old lady with a known FAP who had undergone a pan A 24-year-old lady with a known FAP who had undergone a panproctocolectomy with an ileal pouch-anal anastomosis and total thyroidectomy, later was complicated with acute abdomen for symptomatic desmoid tumour. Computed tomography of the abdomen showed a large intraperitoneal heterogenous mass with small bowel displacement and was confirmed by magnetic resonance imaging. An exploratory laparotomy and en-bloc resection of the tumour with an end ileostomy were performed. Results and discussion: Intra-abdominal desmoid tumours usually pre Intra-abdominal desmoid tumours usually present as a painless slow-growing mass, however, in severe form, it can cause bowel ischemia, intestinal obstruction, or deterioration of function in the ileoanal anastomosis, among post total colectomy. Surgery is indicated upfront in specific clinical scenarios namely complications (occlusion, perforation, or bleeding) or major cosmetic issues. Conclusions: Desmoid tumour, despite being benign, is challenging to manage due to its compressing nature. As a key point, the diagnosis of a desmoid tumour should be suspected and followed up closely in patients with a previous history of FAP in combination with extracolonic manifestation

Helicobacter pylori cagA gene variants in Malaysians of different ethnicity

We have defined DNA repeat variability in the 3′-terminus of the cagA gene of Helicobacter pylori strains from Malaysian patients of different ethnicities. We identified different alleles based on the EPIYA repeats. cagA types A-B-D and A-B-B-D are more similar to the sequence of Japanese strains, whereas cagA types A-B-C, A-B-C-C, A-B and A-C displayed similarity to strain 26695 sequences. A significant association was found between cagA genotypes and patients’ ethnicity, with cagA type A-B-D being predominantly isolated from Chinese patients and cagA type A-B-C from Malays and Indians. Our data further corroborate the possibility that variant biological activity of CagA may affect the host specificity and/or pathogenicity of H. pylori

Factors associated with the recurrence of complicated diverticular disease

Colonic diverticula is observed in over 60% of the western population aged over 80 where up to 30% will eventually be symptomatic and may develop complications. The natural history and etiology of colonic diverticula have been well described. However, predictive indicators of complicated diverticular disease are not known thus preventing the prophylactic treatment of this subset of patients,. The aim of this study was to observe patients with complicated diverticular disease in order to identify common factors associated with recurrent complications. All hospital admissions from January 2005 to December 2008 for complications of diverticular disease were recruited. Using logistic regression, demographic data and factors such as clinical presentation, nature of complication, lifestyle, concomitant medical illness and medications that may be associated with recurrent episodes of complications were analyzed. A total of 121 patients were diagnosed with complicated diverticular disease during the study period with 24 patients having recurrent complications. Logistic regression analysis performed after controlling for confounders found active smoking (p=0.006) and alcohol consumption (p=0.036) along with underlying diabetes (p=0.031) and dyslipidemia (p=0.039) significantly associated with an increased risk of recurrent complications. We therefore concluded that smoking, alcohol consumption, diabetes mellitus and dyslipidemia are associated with recurrent complicated colonic diverticular disease. As these are modifiable risk factors, they should be sought for during the presentation of the first attack. Aggressive control of these factors will help in reducing the risk of recurrent complications