Occult Blood Test Research Articles

Gastrointestinal Bleeding

Gastrointestinal bleeding occurs when a pathologic process such as ulceration, inflammation, or neoplasia leads to erosion of a blood vessel. Bleeding can occur in the upper gastrointestinal tract (50%) or the lower gastrointestinal tract (40%) or may be obscure (10%), meaning that no definitive source is identified. Gastrointestinal bleeding is common, with major bleeding leading to 1 million hospitalizations every year in the United States. This review details the pathophysiology of gastrointestinal bleeding and the stabilization and assessment, diagnosis, treatment, and disposition and outcomes of patients with gastrointestinal bleeding. Situations requiring special consideration are also discussed. Figures show how gastrointestinal bleeding occurs when a pathologic process causes erosion of the mucosa and exposes a submucosal blood vessel; an ulcer with a raised, red, variceal spot; a Mallory-Weiss tear; the formation of varices; vascular ectasia; treatment of esophageal varices with balloon tamponade; and a wireless capsule. Tables list the major causes of gastrointestinal bleeding, terms relating to gastrointestinal bleeding and their definitions, Blatchford score, substances that interfere with occult blood testing, clinical factors differentiating gastrointestinal bleeding placed in descending order of likelihood ratio, and a summary of American College of Radiology recommendations for angiography in nonvariceal gastrointestinal bleeding. This review contains 7 highly rendered figures, 6 tables, and 140 references.

KORELASI ANTARA PERIKSAAN DARAH SAMAR TINJA MENGGUNAKAN ANTI-HEMOGLOBIN MANUSIA DAN PENGAMATAN MIKROSKOPIS

Test for occult blood in faeces is an important part of the early detection of colorectal cancer, gastrointestinal bleeding, and anaemia.Colorectal cancer is the second leading cause of cancer deaths in the United States. Immunochemistry method for detection of humanhaemoglobin in faeces has been developed. The advantages of this method are improving analytical sensitivity and specificity, alsoavoiding the dietary restrictions requirement, compared with benzidine test, and guaiacum test. A study was performed to correlate theresult of fecal occult blood by immunochemistry method using anti-human haemoglobin and microscopic examination of red blood cellsin faeces of outpatients in the Clinical Pathology Laboratory, Dr. Soetomo Hospital, Surabaya. Faeces of fifty one patients tested for fecaloccult blood were examined by immunochemistry method compared with microscopic examination of red blood cells. Comparison ofthe two methods was done by statistical analysis, Mc Nemar test. The correlation was measured using ROC curve. The results showed acorrelation between immunochemistry method and microscopic examination with average red blood cells (RBC) ≤ 2/hpf, p = 0.008; RBC≥ 3/hpf, p = 0.289. ROC curve showed r = 0.941. In conclusion, a significant correlation between positive results of immunochemistrymethod and microscopic examination with average red blood cells ≥ 3/hpf. Further research using larger and more representativesamples should be carried out.

KEUNTUNGAN DAN KERUGIAN PENJAMINAN MUTU BERDASARKAN UJI MEMASTIKAN KECERMATAN (POCT)

Laboratory examination especially for critical care such as emergency care, intensive care has been developed near the site of patientcare which is referred to point-of-care testing (POCT). As to the definition of POCT, there are many synonyms such as ancillary testing,satellite testing, and bedside testing, near patient testing, home testing, self-management, patient self-management, remote testing andphysician's office laboratories. Based on evidence-based POCT, the National Academy of Clinical Biochemistry (NACB) has recommendedsome POCT such as coagulation tests, transcutan bilirubin testing, marker for acute coronary syndromes, diabetes mellitus, drugsand ethanol, Infectious disease testing, occult blood test, pH testing, renal function test, intraoperative PTH, renal function test andreproduction test. Some researchers conclude that performing POCT for critical care is efficient, while others found it not efficient,therefore, careful assessment of the advantages and disadvantages is important when implementing POCT. Nurses are the personnelin the acute care unit who often perform POCT; however they desire that laboratory personnel take the responsibility, therefore it isimportant to discuss which personnel are appropriate to conduct quality control of POCT.

COLORECTAL SCREENING. FIRST RESULTS

Objective: retrospective evaluation of the results of the 2nd stage of implemented colorectal screening program by colonoscopy. Materials and methods . In 2015–2017, The Department of Health of the Tyumen region is implementing a colorectal screening program. First stage of the program: the test for occult blood, 2nd stage: screening colonoscopy. Results. Achieved 2157 screening colonoscopies for patients aged 55–65 years with a positive fecal immunochemical test for fecal occult blood. In 531 (24.6 %) patients adenoma and adenocarcinoma of the rectum and colon were revealed (adenomas verified in 365 (23.1 %) cases, adenocarcinoma – in 33 (1.5 %) cases). Of the total number of verified neoplasia (618 cases of localization), 365 (59 %) cases of adenoma and adenocarcinoma were located in the rectum and sigmoid colon, 253 (41 %) cases – in the descending colon, transverse colon, ascending colon and cecum. Conclusions. In the completed study, the fecal immunochemical test and, with a positive result, a video-colonoscopy were performed at the 1st stage of colorectal screening for patients aged 50–65 years. In 98 % of cases, intubation of the cecum and the time of colonoscope removal for at least 6 minutes allowed to obtain a value of adenoma detection rate ~25 %, which is indicator of the effectiveness of the performed colorectal screening.

Application of NICE guideline NG12 to the initial assessment of patients with lower gastrointestinal symptoms: not FIT for purpose?

Background The National Institute for Health and Care Excellence (NICE) published NG12 in 2015. The referral criteria for suspected colorectal cancer (CRC) caused controversy, because tests for occult blood in faeces were recommended. Faecal immunochemical tests for haemoglobin (FIT), which estimate faecal haemoglobin concentrations (f-Hb), might more than fulfil the intentions. Our aim was to compare the utility of f-Hb as the initial investigation with the NICE NG12 symptom-based guidelines. Methods Data from three studies were included. Patients had sex, age, symptoms, f-Hb and colonoscopy and histology data recorded. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of f-Hb and NG12 were calculated for all significant colorectal disease (SCD: CRC, higher risk adenoma and inflammatory bowel disease). Overall diagnostic accuracy was also estimated by the area under the receiver operating characteristic curve (AUC). Results A total of 1514 patients were included. At a cut-off of ≥10 µg Hb/g faeces, the sensitivity of f-Hb for CRC was 93.3% (95% confidence interval (CI): 80.7-98.3) with NPV of 99.7% (95%CI: 99.2-99.9). The sensitivity and NPV for SCD were 63.2% (95%CI: 56.6-69.4) and 96.0% (95%CI: 91.4-94.4), respectively. The NG12 sensitivity and NPV for SCD were 58.4% (95%CI: 51.8-64.8) and 87.6% (95%CI: 85.0-89.8), respectively. The AUC for CRC was 0.85 (95% CI: 0.87-0.90) for f-Hb versus 0.65 (95%CI: 0.58-0.73) for NG12 ( P < 0.005). For SCD, the AUC was 0.73 (95%CI: 0.69-0.77) for f-Hb versus 0.56 (95%CI: 0.52-0.60) for NG12 ( P < 0.0005). Conclusion f-Hb provides a good rule-out test for SCD and has significantly higher overall diagnostic accuracy than NG12.

Experimental study on blood gases and acid-base parameter changes following oral administration of injectable enrofloxacin 5 % to the horses

The objective of this investigation was to evaluate the effects of oral administration of bovine injectable enrofloxacin 5 % on blood gases, acid–base parameters, risk of gastrointestinal ulcers, bleeding, diarrhea, abdominal pain, and clinical joint disturbances in horses. For this purpose, there were nine selected mixed breed horses with ages between 11 month and 15 years old. These horses were divided into three groups of three animals. Bovine injectable enrofloxacin 5 % was administered orally, 5 mg/kg to the first group and 15 mg/kg to the second group, every 12 h, for 21 days. The third or control group did not receive drug but saline in the same way. Heparinized blood samples were collected for evaluation of blood electrolytes and blood gas parameters as well as recording the clinical findings in animals. Occult blood test was performed in all horse stool samples, in five times, before and after the administration of the drug. As a result, the analyzed data did not show significant changes in blood gases and electrolyte parameters, between drug-administered and control groups. There were no observed mucosal ulcer, injury or symptoms of diarrhea, abdominal pain, and gastrointestinal bleeding in the horses. One of the horses showed swollen in the left carpal joint with a dose of 5 mg/kg of drug, at day 12, which improved with suitable treatment until day 20. This study showed that 3 weeks of oral administration of enrofloxacin 5 % had no significant effect on blood gases and electrolyte parameters even at high doses (15 mg/kg). This study showed the lack of drug effect on producing gastrointestinal mucosal ulcers and colic pain in the drug-treated horses. It was recommended that the drug enrofloxacin should not preferably be used in foals and also in mature horses for long duration, because of the possible joint disorder, and its usage should be with caution.

Infliximab does not increase colonic cancer risk associated to murine chronic colitis.

AIMTo explore the influence of Infliximab (IFX) on cancer progression in a murine model of colonic cancer associated to chronic colitis.METHODSAOM/DSS model was induced in C57BL/6 mice. Mice were injected with IFX (5 mg/kg) during each DSS cycle while control mice received saline. Body weight, occult blood test and stool consistency were measured to calculate the disease activity index (DAI). Mice were sacrificed at week 10 and colons were analyzed macroscopically and microscopically for number of cancers and degree of inflammation. MTT assay was performed on CT26 to evaluate the potential IFX role on metabolic activity and proliferation. Cells were incubated with TNF-α or IFX or TNF-α plus IFX, and cell vitality was evaluated after 6, 24 and 48 h. The same setting was used after pre-incubation with TNF-α for 24 h.RESULTSIFX significantly reduced DAI and body weight loss in mice compared with controls, preserving also colon length at sacrifice. Histological score was also reduced in treated mice. At macroscopic analysis, IFX treated mice showed a lower number of tumor lesions compared to controls. This was confirmed at microscopic analysis, although differences were not statistically significant. In vitro, IFX treated CT26 maintained similar proliferation ability at MTT test, both when exposed to IFX alone and when associated to TNF-α.CONCLUSIONIFX did not increase colonic cancer risk in AOM-DSS model of cancer on chronic colitis nor influence directly the proliferation of murine colon cancer epithelial cells.

Derivation and Validation of a Scoring System to Stratify Risk for Advanced Colorectal Neoplasia in Asymptomatic Adults: A Cross-sectional Study.

Several methods are recommended equally strongly for colorectal cancer screening in average-risk persons. Risk stratification would enable tailoring of screening within this group, with less invasive tests (sigmoidoscopy or occult blood tests) for lower-risk persons and colonoscopy for higher-risk persons. To create a risk index for advanced neoplasia (colorectal cancer and adenomas or serrated polyps ≥1.0 cm, villous histology, or high-grade dysplasia) anywhere in the colorectum, using the most common risk factors for colorectal neoplasia. Cross-sectional study. Multiple endoscopy units, primarily in the Midwest. Persons aged 50 to 80 years undergoing initial screening colonoscopy (December 2004 to September 2011). Derivation and validation of a risk index based on points from regression coefficients for age, sex, waist circumference, cigarette smoking, and family history of colorectal cancer. Among 2993 persons in the derivation set, prevalence of advanced neoplasia was 9.4%. Risks for advanced neoplasia in persons at very low, low, intermediate, and high risk were 1.92% (95% CI, 0.63% to 4.43%), 4.88% (CI, 3.79% to 6.18%), 9.93% (CI, 8.09% to 12.0%), and 24.9% (CI, 21.1% to 29.1%), respectively (P < 0.001). Sigmoidoscopy to the descending colon in the low-risk groups would have detected 51 of 70 (73% [CI, 61% to 83%]) advanced neoplasms. Among 1467 persons in the validation set, corresponding risks for advanced neoplasia were 1.65% (CI, 0.20% to 5.84%), 3.31% (CI, 2.08% to 4.97%), 10.9% (CI, 8.26% to 14.1%), and 22.3% (CI, 16.9% to 28.5%), respectively (P < 0.001). Sigmoidoscopy would have detected 21 of 24 (87.5% [CI, 68% to 97%]) advanced neoplasms. Split-sample validation; results apply to first-time screening. This index stratifies risk for advanced neoplasia among average-risk persons by identifying lower-risk groups for which noncolonoscopy strategies may be effective and efficient and a higher-risk group for which colonoscopy may be preferred. National Cancer Institute, Walther Cancer Institute, Indiana University Simon Cancer Center, and Indiana Clinical and Translational Sciences Institute.

Highlights of This Issue

Higher breast cancer mortality rates for African-American women compared to non-Hispanic white women are well documented. Tao and colleagues examined data from California breast cancer patients to ask if this disparity persists across disease subgroups and stages at diagnosis. The authors report substantially higher hazards of breast cancer death among African-American women with stage II/III HR+/HER2− and stage III triple-negative cancers relative to whites. These data provide insights to target particular subtypes of breast cancer among African-American patients.Symptomatic gastroesophageal reflux disease (sGERD) elevates the risk for esophageal adenocarcinoma (EAC), but studies suggest that sGERD contributes to only approximately 16% of EAC. Hazelton and colleagues developed a multiscale model to estimate the role of factors other than sGERD that contribute to EAC development. The authors found that 77.8% of male EAC and 32.6% of female EAC is attributable to factors other than sGERD, including obesity. EAC surveillance should target individuals with both long-duration sGERD and high body mass index.High body mass index (BMI) is linked to increased risk of colorectal cancer for men, but risk estimates from observational studies can be biased and/or confounded. Thrift and colleagues used data from colorectal cancer cases and controls and conducted a Mendelian randomization analysis of weighted genetic risk scores to estimate the causal association between BMI and colorectal cancer. The authors report that subjects carrying greater numbers of BMI-increasing alleles had higher colorectal cancer risk. Thus, both Mendelian randomization and epidemiologic studies suggest a strong association between obesity and the risk of colorectal cancer.Fecal occult blood testing (FOBt) reduces colorectal cancer mortality, but the test has low sensitivity. Miles and colleagues examined the psychological impact of a missed cancer in a FOBt-screened population. The authors compared patients with screen-detected disease to patients with a missed FOBt-screened cancer and found that patients with a missed cancer report low levels of trust in FOBt and poorer quality of life. Improvements in FOBt sensitivity could improve quality of life among people who complete an FOBt screen.

PWE-281 Are patients with cancers ‘missed’ on faecal occult blood (FOB) testing truly asymptomatic? – a multicentre analysis

Introduction We aimed to identify the symptomatology of patients who develop interval cancers (cancers diagnosed within 2 years of a negative FOBT screening) in the eligible population of the East Midlands region. Method Data from the National Bowel Cancer Audit Programme from three tertiary colorectal centres (Queens Medical Centre, Nottingham; Royal Derby Hospital and Sherwood Forest Hospitals ll) in the FOB testing age group (60–74 years) over 2 years (August 2011 to August 2013) were analysed and linked to the regional FOB hub to identify patients who had developed colorectal cancer after a negative FOBT in the screening interval (2 years) status. Tumours from and distal to the splenic flexure were classed as left sided tumours. Dukes C/D tumours were classed as advanced tumours. All three centres were in incident rounds of screening. Results The study covered a population of 2 million of which 200,000 were eligible for screening. 521 colorectal cancers were diagnosed in the above population (0.11%). Of these, 231 cancers (44%) were in patients who had declined screening,162 (31%) were picked up following on from a positive FOBT and 128 (25%) were picked up in patients who had a negative FOBT. Of these 128 patients (M: F; 84:44),median age 67 years (SD:3.8) the commonest presenting symptoms for these patients were change in bowel habits in 50(39%). Other presentations included bleeding per-rectum in 44 patients (34%), abdominal pain in 38 (30%) patients, anaemia in 36(28%) patients, loss of weight in14 (11%)patients, bowel obstruction in 13 (10%) patients, bowel perforation in 3(2%) patients. Only two patients were truly asymptomatic from the bowel cancer with this being identified in one patient during surgery for an ovarian cyst and during a trauma laparotomy in the other patient. In the 28% patients who had anaemia the blood picture included a Hb (mean)of 10.3gm;MCV of 82.4 and;MCH of 26.3. In 61% of anaemic patients, the cancer was located on the right side of the colon with an equal percentage being of advanced Duke’s stage. The median interval between the negative FOB test and the diagnosis of cancer in these patients was 15 months (range 0.5–24 months). Conclusion Our findings suggest that the majority of patients with ‘missed’ interval cancers were symptomatic with ‘red flag symptoms’ inspite of the negative FOB test. We also raise the possibility of a natural bias of subjects volunteering for the FOB test in that some who opt for the test may not be ‘truly’ asymptomatic but may have bowel symptoms not yet discussed with their general practitioner. We highlight the need for improved awareness to reduce delays in symptomatic patients seeking medical advice against a background of a negative FOBT. Disclosure of interest None Declared.

Colorectal cancer screening.

Colorectal cancer is one of the most common malignancies in Australia, and screening to detect it an earlier stage is cost-effective. Furthermore, detection and removal of precursor polyps can reduce incidence. Currently, there are limited data to determine the screening rate in Australia, but it is certainly lower than the 80% screening rate considered desirable. Whether colonoscopy is used as the screening test or to follow up positive results of an initial non-invasive test, it plays a fundamental role. Despite high sensitivity and specificity, it is expensive and invasive with measurable risk and is not acceptable as an initial test to many participants. It does not provide complete protection, and interval cancers between planned colonoscopies are associated with proximal location, origin in sessile serrated adenomas and operator-dependent factors. An essential component of colorectal screening is the measurement of colonoscopy quality indicators, such as caecal intubation and adenoma detection rates, which are known to be associated with the rate of interval cancer. The non-invasive screening test currently recommended in Australia is biennial testing for faecal occult blood between the ages of 50 and 75 using a faecal immunochemical test, with positives evaluated by colonoscopy. This is provided through the National Bowel Cancer Screening Programme, currently for those at the ages of 50, 55, 60 and 65 years, with full implementation of biennial screening by 2020. To improve screening in Australia, the most fruitful approach may be to acknowledge that there is a choice of screening tests and to focus on the goal of improving overall participation rate and being able to measure this.

Therapeutic effect evaluation on the treatment of acute upper gastrointestinal bleeding with freezing Zidi mixture lavage

Objective To observe the clinical effects of treating acute upper gastrointestinal bleeding（AUGIB） with freezing Zidi mixture lavage. Method 183 UGIB patients from the First Affiliated Hospital to Guanzhou University of TCM in August 2013 were randomly recruited into a control group with 91cases and a treatment group with 92 cases. The treatment group was treated with intragastric administration of freezing Zidi mixture, while the control group was treated with intragastric administration of cryohydrate and norepinephrine. The changes of clinical effects, blood pressure, hemoglobin, blood urea nitrogen, pulse and dark stool were observed and the bad emotions as anxiety, depression and fear were evaluated. Results ① On therapeutic effect, the total effective rate was 96.7% and 85.7% in the treatment group and the control group respectively, with statistical difference（χ^2=2.943,P〈0.05）. ② On the time of symptom disappearance：the disappearing time of vomiting, dark stools and occult blood test in the treatment group was obviously shorter than the control group after the treatment（t=6.628、14.052、21.706,P〈0.05 or 0.01）. ③ On body symptom changes： after the treatment, the systolic pressure, heart rate, hemoglobin, and blood urea nitrogen [（114.3±12.1）mmHg,（78.6±11.4）/min,（98.1±10.5）g/L,（5.9±1.1）mmol/L] in the treatment group were all obviously improved than those [（106.3±11.2）mmHg, （88.7±12.1）/min,（88.2±11.7）g/L,（6.9±1.4）mmol/L] in the control group;body temperature returned to normal in both groups, and there was no statistical difference score was either in or between groups（P〉0.05）. ④ On changes of anxiety, depression and fear：the treatment group [the（42.5±9.4）, （41.6±9.7）, （26.3±5.4）for each]was obviously improved after the treatment than the control group[the score was（51.2±10.1）,（50.4±11.5）,（30.4±6.9）for each],P〈0.05. Conclusion Freezing Zidi mixture lavage can obviously elevate systolic pressure, decrease heart rate, enhance hemoglobin, decrease blood urea nitrogen, relieve body stress reaction and other clinical symptoms. Its effects were better than intragastric administration of cryohydrate and norepinephrine in treating AUGIB. Key words: Freezing Zidi mixture; AUGIB; Intragastric administration

An effective inequity reduction intervention: evaluating what made it work

Background Recent healthcare literature points to the need to investigate how to achieve inequity reduction. We studied the implementation of an organizational-wide inequity reduction intervention in Israel’s largest healthcare provider and insurer, Clalit Health Services during 20092012. The intervention focused on reducing health and healthcare gaps between 55 target clinics (major clinics serving predominantly minority and socioeconomically deprived populations) and all other 126 major primary care clinics. The intervention focused on inequity reduction in a composite weighted score of seven indicators: attainment of diabetes, blood pressure, and lipid control; lack of anemia in infants; and performance of mammography, occult blood tests, and influenza vaccinations.

Tu1736 IL-33/ST2 Axis Modulates Epithelial Repair and Gut Mucosal Wound Healing in DSS-Colitic Mice

Background. Increasing evidence confirms that IL-33 and its receptor, ST2, are important factors in the pathogenesis of IBD. However, animal studies have yielded ambiguous results, reporting both pathogenic as well as protective functions. The aim of our study was to characterize and functionally evaluate the precise role of the IL-33/ST2 axis following acute epithelial injury and mucosal repair in dextran sodium sulphate (DSS)-induced colitic mice. Methods. 3% DSS was administered for 5d to C57/BL6 wild-type (WT), IL-33 KO and ST2 KO mice to induce colitis. DSS was then replaced with regular drinking water for 2 wks (recovery period). Another group of WT mice received DSS for 5d and IL-33 (33ug/kg, i.p.) or vehicle (VEH) every other day during the recovery period. Mice were sacrificed either after DSS challenge or after 1 or 2 wks of recovery; control mice (CT) not exposed to DSS were sacrificed at similar time points, at which time colons were harvested. Body weight, occult blood test, and stool consistency were measured daily to calculate Disease Activity Index (DAI), and endoscopic and histological evaluation of colons were performed using established scoring systems. IHC, qPCR and Western blots were done on full-thickness colons for IL-33 and ST2 localization, mRNA expression, and evaluation of protein isoforms, respectively. Results. DSS administered to WT mice resulted in increased body weight loss and DAI. More severe colitis was observed following DSS+1wk recovery vs. after 5d of DSS, which decreased after DSS+2wks recovery. IL-33 mRNA transcripts were dramatically elevated after DSS, and even more so following DSS+recovery vs. CT, but similar to CT after DSS+2wks recovery. ST2 mRNA expression was also increased after DSS+recovery vs. CT, while no difference was found between 5d of DSS challenge and CT and after DSS+2wks recovery. Full-length, bioactive IL33 (31 kDa), ST2L (76 kDa) and sST2 (52 kDa) were expressed in all experimental groups; the cleaved, less active form of IL33 (24 kDa) was increased in only DSS exposed mice vs. CT. IHC showed intense IL-33 and ST2 staining within the inflamed and ulceratedmucosa of DSS-treatedmice. ST2 staining was more evident during the recovery phase following DSS, notably localized to subepithelial myofibroblasts in close proximity to areas of re-epithelialization. Remarkably, both IL-33 and ST2 KO mice showed increased colonic inflammation after 2 wks recovery compared to after 5d DSS and vs also WT, suggesting the importance of IL-33/ST2 axis in mucosal healing. Likewise, IL33 treatment of WT mice resulted in increased body weight, reduced DAI, and decreased colonic inflammation after 2 wks recovery vs. VEH. Conclusions. Our results suggest that activation of the IL-33/ST2 axis promotes epithelial repair and mucosal healing following acute epithelial injury during DSS-induced colitis.

Absence of HHV8 in colon cancer in cameroon

Background Colon cancer is the third most commonly diagnosed cancer in the world; for over 40 years, the incidence has reportedly been lower in West Africans than in Caucasians. HHV8 is a prevalent virus in equatorial Africa were Kaposi’s sarcoma was endemic even before the AIDS epidemic. As a result of the long period of evolutionary history in Africa, there is more genetic diversity between populations living within the African continent than between Africans and the rest of mankind. Not only do populations within Africa vary considerably with respect to their genes, but across the continent there is a very wide range of environments, in terms of climate and vegetation. For all of these reasons, one might expect a wide diversity of cancer patterns, the study of which would be illuminating to our understanding of the causes of human cancer. Cameroon is a blank area on the world cancer map because medical facilities necessary for recording cancer cases and the population data necessary for the calculation of rate are scarce or non-existent. Only 10% of malignant neoplasms are confirmed by histology. Pathology facilities are not available. There are fewer than 10 pathologists and 5 oncologists for the whole population of Cameroon. Liver cancer is the most common cancer with virtually a 100% mortality rate. Cervical cancer and breast cancer each represent 11% of the total cancer cases in the population. Colon cancer is becoming common. Purpose We carried out this descriptive study to find out if HHV8 may be found in colon cancer in our environment where the disease was previously rare. Kaposi’s sarcoma is still epidemic in rural area in this country after the introduction of antiretroviral therapy. Material and method 30 paraffin blocks of colon cancer underwent immunohistochemistry with HHV8 antibodies. Results 135 cases of colon cancer were reported in our single institution over a five year period (2005–2010). Before year 2004, colon cancer was rarely reported in our hospital with less than ten cases per year. It is also known than colonoscopy and occult blood test have been introduced 15 years ago. No case of colon cancer in this series was positive for HHV8 antibody. Conclusion Colon cancer is becoming common in low prevalent settings and no association with HHV8 was found in this series.

Patient perceptions of stool DNA testing for pan-digestive cancer screening: a survey questionnaire.

To explore patient interest in a potential multi-organ stool-DNA test (MUST) for pan-digestive cancer screening. A questionnaire was designed and mailed to 1200 randomly-selected patients from the Mayo Clinic registry. The 29-item survey questionnaire included items related to demographics, knowledge of digestive cancers, personal and family history of cancer, personal concern of cancer, colorectal cancer (CRC) screening behavior, interest in MUST, importance of test features in a cancer screening tool, and comparison of MUST with available CRC screening tests. All responses were summarized descriptively. χ(2) and Rank Sum Test were used for categorical and continuous variables, respectively. Completed surveys were returned by 434 (29% aged 50-59, 37% 60-69, 34% 70-79, 52% women). Most participants (98%) responded they would use MUST. In order of importance, respondents rated multi-cancer detection, absence of bowel preparation, safety and noninvasiveness as most attractive characteristics. For CRC screening, MUST was preferred over colorectal-only stool-DNA testing (53%), occult blood testing (75%), colonoscopy (84%), sigmoidoscopy (91%), and barium enema (95%), P < 0.0001 for each. Among those not previously screened, most (96%) indicated they would use MUST if available. Respondents were confident in their ability to follow instructions to perform MUST (98%). Only 9% of respondents indicated that fear of finding cancer was a concern with MUST, and only 3% indicated unpleasantness of stool sampling as a potential barrier. Patients are receptive to the concept of MUST, preferred MUST over conventional CRC screening modalities and valued its potential feature of multi-cancer detection.

Prevalence ofClostridium difficiletoxin in diarrhoeal stool samples of patients from a general hospital in eastern province, Saudi Arabia

Introduction<italic>Clostridium difficile</italic> is anaerobic spore-forming bacillus, produces two major toxins (Tcd A and Tcd B). Disease caused by toxigenic <italic>C.difficile (Tcd)</italic> varies from mild diarrhea to fulminant disease and death.Aims and ObjectivesThis study describes the prevalence of <italic>C.difficile</italic> toxins (CDT) in stool samples from in patients and outpatients of all age groups.Materials and MethodsA total of 146 samples were examined from 2011 to 2012 were analyzed for the presence of CDT tests, DNA amplification test, and the stool samples were cultured anaerobically on CCFA selective medium for growth-Morphology, identification and other tests. The patient's details are collected from the medical records.ResultsOut of 146 specimens, only 20 (13.7%) were positive for <italic>C.difficile</italic> toxins. Male and female were 12 (60%) and 8(40%) respectively, with the majority of them aged between 16 to 71 years. Majority of them were from out patient units (n = 5, 25%) with rest from intensive care units (n = 3, 15%), male medical ward (n =3, 15%) and surgical wards (n = 1, 5%). All the CDT positive patients had history of prior antibiotic usage before the detection of toxin. Mean duration of antibiotic usage was a 16.75 (±12.75) days, and the mean duration of diarrhea was 4.21 (±4.85) days, 16 patients had underlying medical illness, like hypertension, diabetic mellitus etc; Stool with pus cells and occult blood test was positive among that 18 patients were positive for CDT. The hospitalized patient duration was 20.96 (±16.25) days.The detection of CDT in the diagnosis of CDI requires vigilance by both clinician and microbiologist to look out for possible infected patients. Antibiotic usage is a known risk factor; thus restricted use of antibiotics may results the reduction of CDI.

Colorectal cancer prevention: screening and the role of aspirin

SUMMARY Colon cancer is the third most common cancer worldwide. Sigmoidoscopy and colonoscopy, with the removal of rectal and colon polyps, are proven strategies for the prevention of colon cancer, and testing for fecal occult blood helps to identify subjects suitable for endoscopy. Evidence that low-dose aspirin is associated with a substantial reduction in colon cancer risk and reduces the number and growth of colon polyps is accumulating from randomized trials and observational studies. Advantages and disadvantages of endoscopy and aspirin prophylaxis are discussed extensively in this review. The reduction in cancer incidence by the two approaches together is considerably enhanced as they complement each other. Expenditure could become more cost effective if the two were promoted together.

Development of Rapid Diagnostic Technology for Pig Disease (2) - Rapid detection of PPE in the pig feces -

Purpose: Porcine proliferative enteropathy (PPE), caused by the obligate intracellular bacterium Lawsonia intracellularis, is a widely distributed disease throughout the world causing substantial economic loss. In order to diagnose PPE rapidly, the rapid kit was developed and tested. Methods: In this study, a rapid kit was developed to screen the PPE rapidly at the pig farm. Also, occult blood test with fecal occult blood (FOB) kit was done for detecting the blood in pig feces which might be the evident of hemorrhagic PPE. For developing the kit, we tested fecal samples of PPE infected pigs diagnosed by polymerase chain reaction (PCR) method. Results: With the developed rapid kit, Lawsonia intracellularis was detected in high density emulsion of ileum. On the other hand, the test result of detecting Lawsonia in feces showed too high non-specific response. In addition, nevertheless the FOB test result showed that blood evident could be founded in pig feces, the diagnosing result was not fit to PCR test result, which shows blood in pig feces could be from not only hemorrhagic PPE but also many reasons. Conclusions: To deal with the PPE effectively, it will be better for farmers to screen the PPE in earlier stage with easy and rapid diagnosing tool on farm. This study found out that the rapid kit could detect the Lawsonia intracellularis and hemoglobin in pig feces. However, the non-specific response to negative samples of PPE was too high to use at a pig farm. Further research is needed for lowering the non-specific response with the rapid kit.

Barriers for compliance to breast, colorectal, and cervical screening cancer test among Hispanics patients.

e12544 Background: Hispanics are less likely to undergo colorectal cancer and cervical cancer screening tests than non-Hispanic population. We address the barriers for compliance in a Hispanic community. Methods: A descriptive study was performed with 194 patients between 21 to 85 y/o, while they attended routine medical encounters at a private and a government sponsored clinics. Compliance and barriers for non compliance for mammography (MAMMO), occult blood testing (FOBT), colonoscopy (COLO) and cervical smears (Pap) were studied. Univariate and bivariate tests were used. Results: Females (62.9%) had a mean age of 53.4 ±15.0; had a high school diploma or higher degree (80.5%), unemployed (52.15), had private health insurance (68.0%), and practiced routine medical checkups (79.9%). Gender differences for patients undergoing FOBT and COLO were found only in patients older than 50 y/o. Females were more likely than males to undergo COLO (62.3% vs. 42.2%; p&lt;0.05) whereas males are more likely than females to had a FOBT (66.7% vs. 56.5%; p&gt;0.05). Differences between employed and unemployed patients undergoing FOBT were seen (48.4% vs. 65.1%; p=0.105) and COLO (38.7% vs. 60.2%; p=0.040). Seventy four percent of women between 40 to 65 y/o had a Pap and 85% had a MAMMO. Predominant reasons for avoiding MAMMO and Pap were fear (20%; p&lt;0.05 and 6%; p&gt;0.05), uncomfortable sensation (13%; p&lt;0.05 and 19%; p&lt;0.05), lack of time (67%; p&lt;0.0001 and 56%; p&lt;0.0001). Reasons for avoiding FOBT and COLO were not recommended by physician (42%; p&lt;0.05 and 52%; p&gt;0.05) and lack of knowledge (16%; p&lt;0.05 and 17%; p&lt;0.05). Conclusions: Occupational status in women (p&lt;0.05) was found as a barrier for compliance with screening MAMMO, while it was also a barrier for COLO in both men and female over the age of 50. (p&lt;0.05) Educational level in men and women was not associated with non compliance with FOBT or COLO in patients older than 50 y/o. Having a private health insurance is a predictor of compliance with MAMMO (71.3%), FOBT (78.3%), COLO (80.6%), and Pap (68.6%). Several physician and patient related factors were identified as barriers for compliance. Study was supported by NIH grant #'s 8U54MD007587 &amp; 8G12MD007583.