Correlation of Pretreatment Hemoglobin and Platelet Counts with Clinicopathological Features in Colorectal Cancer in Saudi Population

Background/Aims:

In Saudi Arabia, colorectal cancers (CRCs) are registered as the second most common cancers. However, no data has been reported about correlation of the severity of the anemia and pretreatment platelets level with clinicopathological features of CRCs. We aimed to evaluate the association between pretreatment hemoglobin and platelets level and the clinicopathological features of CRC patients in Saudi Arabia.

Materials and Methods:

Between September 2005 and November 2011, One hundred and fifty-four confirmed CRC patients underwent thorough physical examination, blood investigations, endoscopic ultrasonography (EUS), and computed tomography (CT) for staging before surgery. Findings of physical assessment, EUS, CT, and pathological specimens were correlated with pretreatment hemoglobin and platelets levels the Pearson-Kendall tau correlative coefficients.

Results:

The mean age of cohort was 56.6 years (range: 26-89). Left-sided CRC were predominant (97 patients; 63%). Mean size of primary tumor was 6 cms (1-18) SD ± 3.55. Mean values of hemoglobin, red blood cells, hematocrit, white blood cells, and platelets were 11.9 SD ± 2.3, 35.5 SD ± 5.7, 4.43 × 10⁶/mL SD ± 0.6, 7.67 10⁶/mL SD ± 2.44, and 343 × 10³/mL SD ± 164.4, respectively. Pretreatment hemoglobin was inversely correlated with primary tumor size (R: 0.71, R^2: 1.55, P = 0.0001) and nodal status (R: 0.02, R^2: 0.05, P = 0.01). Right-sided CRC had significantly low pretreatment hemoglobin levels (P = 0.001). Interestingly, pretreatment thrombocytosis was seen only in right-sided CRC (P = 0.0001).

Conclusion:

Pretreatment anemia and thrombocytosis were found mainly in right-sided CRCs and advanced primary and nodal stages. Pretreatment hemoglobin and thrombocytosis can be considered as useful prognostic markers in CRC patients.     

Diffuse alopecia in a child due to dietary zinc deficiency

A 4-year-old girl was evaluated for hair loss of a few weeks' duration. History of the present illness, medical history, and review of systems were obtained from the parents, who described progressive diffuse hair loss with hair dryness and brittleness, with no change in the child's eating habits or any other unusual symptoms. No fever, weight loss, diarrhea, vomiting, abdominal pain, chronic cough, dyspnea, change in appetite, change in bowel habit, or urinary symptoms were noted. On further questioning, her nutritional history revealed that she always favored cow's milk in her diet. The patient has been healthy with no significant medical history, surgical history, psychiatric history, or history of hospitalization. She was taking no medications. Her mother's pregnancy and the child's birth history were uneventful. The child was up-to-date on her vaccinations. Her physical examination showed a healthy-appearing child who was at 50% on the height chart and 70% on the weight growth chart. She was afebrile with a respiratory rate of 24 breaths per minute, pulse rate of 110 beats per minute, and pulse oximetry of 99% on room air. Skin examination revealed interstitial diffuse patchy alopecia with very dry hair and nonscarred, normal-appearing scalp. The hair pull test was normal, with 4 hairs extracted. Results of examination of her eyes (including visual acuity) and lungs were normal, and no abnormalities were found on heart, abdominal, musculoskeletal, and neurologic examinations. Laboratory workup showed normal electrolytes, blood urea nitrogen, creatinine, and blood sugar levels. Her complete blood cell count with differential was normal, ferritin concentration level was 110 ng/mL (reference, 40-200 ng/mL), iron level was 75 microg/dL (reference, 35-175 microg/dL), and total iron-binding capacity was 310 microg/dL (reference, 245-400 microg/dL). Levels of liver enzymes, total bilirubin, serum protein, and albumin were normal, as were the results of urinalysis. Thyroid function test results were normal and levels of vitamins A and D were also normal. Low levels of serum zinc were measured repeatedly at 48 and 61 microg/dL (reference, 66-144 microg/dL) at 2 different laboratories. She was started on zinc supplement (50 mg daily) for 6 months and her diet was modified. The hair loss stopped in 3 weeks. Follow-up in 4 months showed no evidence of alopecia, with normal-looking hair.     

A new web-based operative skills assessment tool effectively tracks progression in surgical resident performance

PURPOSE: The study aim was to demonstrate that a new database tool for assessment of surgical resident operative skills discerns predictable progression in those skills over successive residency years for specific index case types. METHODS: A Web-based interactive database (OpRate) was used to assess selected aspects of resident operative performance as determined by supervising attending surgeons in a medium-sized residency (5-6 residents per postgraduate year [PGY]). This assessment consisted of (1) 3 questions pertaining to patient information, technical, and disease-specific preparedness; (2) 4 laparoscopic technical skills questions pertaining to tissue handling, dexterity, planning, and ability to function independently; and (3) similar open technical skills questions, with the addition of 2 questions defining knot tying ability. Two years of assessment data were examined for cholecystectomy (CH), appendectomy (AP), colon resection (CR), ventral hernia repair (VH), and inguinal hernia repair (IH). Mean scores for total, technical, and preparedness responses, as well as each response area were compared for successive training years for each case type. Mean performance data between postgraduate years were compared by ANOVA, and interitem reliability was assessed by Cronbach's alpha determinations. RESULTS: OpRate data for 579 cases (142 CH, 67 AP, 73 CR, 202 IH, and 95 VH) were examined. Significant incremental increases in open and laparoscopic technical skills scores by training year were observed for all case types (ANOVA, p < 0.0001). Individual technical skills as well as technical and disease-specific preparedness response areas also demonstrated significant improvement by successive training year. Cronbach's alpha determinations were 0.80-0.94 for the preparedness test items and the skills performance scores for all assessed procedures. CONCLUSIONS: Our early results show that the OpRate assessment tool is effective in identifying expected changes in operative performance across successive training years, with a satisfactory level of internal consistency for the test items. As such, the use of this database tool may offer the opportunity to (1) define performance benchmarks for specific levels of training and (2) identify areas where focused training may be required for specific residents.     

Thymoquinone and Nigella sativa oil protection against methionine-induced hyperhomocysteinemia in rats

Although the state of hyperhomocysteinemia (HHcy) appears to be associated with higher risks of coronary, cerebral and peripheral vascular disease as well as with a number of other clinical conditions, the underlying molecular mechanisms are not fully elucidated. There is strong evidence, however, that HHcy could induce a pathogenic state of oxidative stress. The interest in modulating the elevated levels of total homocysteine in HHcy and/or their negative impacts through preventive strategies, particularly through the supplementation with vitamins that may be linked to the homeostasis of homocysteine (folate, vitamin B(12), and vitamin B(6)), has increased in recent years. Here we show that active antioxidant components of the traditionally used black seeds of Nigella sativa plant protect against the development of methionine-induced HHcy and its associated state of oxidative stress. Pretreatment of rats with an oral dose of 100 mg/kg of thymoquinone, the main active constituent of the black seed, for 30 min and for 1 week almost completely protected against induced HHcy measured 5 h after methionine load (100 mg/kg). Under similar conditions pretreatment with commercial black seed oil (100 microl/kg) for 30 min and for 1 week produced significant and strong protection levels of 74.2 and 94.5%, respectively. Under the state of induced HHcy there were significant increases in the plasma levels of triglycerides, lipid peroxidation, cholesterol and in the activities of glutathione peroxidase and superoxide dismutase. Catalase activity was not affected. The total antioxidant status, however, was significantly depressed. All of these effects were almost totally blocked by prior treatment with thymoquinone or black seed oil. These findings may contribute towards a protective measure utilizing the black seed against the negative impacts of HHcy.     

Effect of hylan G-F 20 in Achilles' tendonitis: an experimental study in rats

OBJECTIVE: To investigate the local effects of hylan G-F 20 on locally administered corticosteroid-induced experimental Achilles' tendonitis. DESIGN: Before-after trial. SETTING: Institutional practice. ANIMALS: Convenience sample of 18 male Wistar white rats (weight range, 322-375 g). INTERVENTIONS: After performing Achilles' degeneration with local corticosteroid injections, the rats were divided into 4 groups. The right Achilles' tendon of the rats served as the hylan injection group and the left tendon as the control group, which was injected with saline at 5-day intervals. The tendons and paratenons were excised at the end of 60 or 75 days and evaluated histopathologically and statistically. MAIN OUTCOME MEASURE: Histopathologic changes, including staining affinity, nuclear appearance, fibrillar appearance for tendon and thickness, occurrence of fibrosis and edema, capillary changes, and inflammation for paratenon, were assessed according to a semiquantitative scoring system. The Mann-Whitney U test was used for statistical analysis, with a P value of.05 or less considered statistically significant. RESULTS: Semiquantitative scoring of histopathologic changes showed that histologic appearances differed between the hylan and saline groups and between 2 hylan groups. Hylan-injected tendons and paratenons demonstrated significantly lower scores, especially after 75 days. CONCLUSIONS: Hylan G-F 20 has a promising curative effect on the tendon and paratenon and can be used in Achilles' tendonitis. This finding should be supported by biomechanical and biochemical studies.     

Maternal-fetal status of copper,iron, molybdenum,selenium and zinc in insulin-dependent diabetic pregnancies

Objective The objective was to assess the status of essential trace elements such as copper, iron, molybdenum, selenium and zinc in insulin-dependent diabetic pregnancies at term and to compare the data with a control group. Fetal-maternal ratios of the elements and copper:zinc ratio were also computed in the control and study populations.Methodology Samples from maternal vein, umbilical artery and umbilical vein of diabetic and control women were collected at the time of spontaneous delivery or cesarean section and activities of trace elements evaluated by atomic absorption spectrophotometry.Results Cu, Fe, Mo, Se and Zn concentrations in maternal venous blood averaged 2,156, 2,020, 13, 102 and 656 g/l in control women (n=17) while in the diabetic group (n=14), the corresponding values for the trace elements averaged 3,135, 3,675, 15, 85 and 628 g/l respectively. Values for copper and molybdenum were significantly higher (p<0.05) in the study group compared to control while those of zinc, iron and selenium were not significantly different (p>0.05). Iron and molybdenum values were significantly higher (p<0.05) and that of zinc significantly lower (p<0.05) in umbilical arterial samples of diabetic group compared to controls. In the case of molybdenum, copper the values were significantly higher (p<0.05) in umbilical venous samples of diabetic group compared to that of control. Significant differences in Cu:Zn ratio of maternal venous and umbilical samples and fetal-maternal ratios of some elements were noted between control and study group as well.Conclusion We speculate that altered status of some essential trace elements and altered antioxidant mineral ratio observed in insulin dependent diabetic patients could have deleterious influences on the health of the mother as well as the fetus and newborn.