At least 6 million deaths occurred worldwide are due to cancer and this figure is expected to rise to
15 millions by the year 2020. Colorectal cancer is among the most commonly occurring cancers
both globally and in Malaysia. Numerous studies have shown significant relationships between
various dietary components and the risks for colorectal cancer. Meanwhile, several theories have
been suggested as etiological explanations, one of which is the influence of dietary factors on the
cell proliferation rate. A higher cell proliferation rate is statistically associated with increased risk
of colorectal cancer. However, evidence of a significant relationship between diet and colorectal
adenomas, a potential precursor for colorectal cancer, remains insufficient. Colorectal adenomas or
polyps are vital in their relationship with colorectal cancers as almost 70% of all colorectal cancers
are developed from these polyps. Studying the modifiable risk factors related to polyps will provide
an opportunity for the prevention of colorectal cancer even before it develops. This paper reviews
the available evidence linking dietary factors with the risk for colorectal adenomas. As the numbers
of published studies are limited, of which most are concentrated in Western countries, there is a
need for epidemiological studies in Malaysia to strengthen the evidence of a relationship between
diet and colorectal adenomas.
Management of Beta (β)-thalassaemia intermedia in contrast to β-thalassaemia major patients has no clear guidelines as to indicators of adequate transfusion. Regular blood transfusion suppresses bone marrow erythropoietic activity. Serum soluble transferrin receptor (sTfR) concentration is a marker for erythropoietic activity, with increased sTfR being associated with functional iron deficiency and increased erythropoietic activity. This study aimed to determine the use of sTfR as an indicator of adequate transfusion in adult β-thalassaemia intermedia patients. A cross-sectional study was conducted at Hospital Ampang, Malaysia, for six months. Patient group included six β-thalassaemia intermedia and 34 HbE-β-thalassaemia transfused patients. None of the patients were on regular monthly blood transfusions as in β-thalassaemia major. The control group comprised of 16 healthy subjects with normal haematological parameters. Haemoglobin (Hb) analysis, sTfR and ferritin assays were performed. Hb and HbA percentages (%) were found to be significantly lower in patients compared to the controls, while HbE%, HbF%, sTfR and ferritin were significantly higher in patients. An inverse relationship was found in the controls between HbF% with Hb (r = -0.515, p < 0.05) and HbA% (r = -0.534, p < 0.05). In patients, sTfR showed an inverse relationship with HbA% (r = -0.618, p = 0.000) and a positive correlation with HbE% (r = 0.418, p = 0.007) and HbF% (r = 0.469, p = 0.002). Multivariate analysis showed that HbA% (r = 2.875, p = 0.048), HbE% (r = 2.872, p = 0.020) and HbF% (r = 2.436, p = 0.013) best predicted sTfR independently in patients. Thus, sTfR is a useful marker for erythropoiesis. The elevated sTfR in these patients indicate that the transfusion regimen used was inadequate to suppress ineffective erythropoiesis. Hb levels may not be the best target for monitoring transfusion treatment in β-thalassaemia intermedia patients, but the use of sTfR is helpful in individualising transfusion regimens.
The effect of ovariectomy and sex hormone/s replacement in female rats was investigated by the determination of the tumour marker enzymes gamma-glutamyltranspeptidase (GGT) and alkaline phosphatase (ALP). This was compared to ovariectomized rats receiving sex hormone replacement and treated with carcinogen. Ovariectomy significantly increased the activity of plasma GGT. Plasma and microsomal ALP and microsomal GGT were unchanged. When replacements of estrogen (E), or progesterone (Prog), or combinations of both estrogen and progesterone were given to ovariectomized rats, the activity of plasma GGT was brought to the level of normal intact females. Treatment with carcinogen increased the PGGT activities in intact rats. In ovariectomized rats receiving carcinogen, the PGGT activities were significantly lower than in intact females and rats receiving both hormone replacement and carcinogen (p < 0.01). Carcinogen treatment in case of estrogen or progesterone replacement, either individually or in combination, showed GGT activities comparable to intact females receiving carcinogen. Both plasma and microsomal ALP were not affected by carcinogen administration. These results showed that ovariectomy reduced the severity of hepatocarcinogenesis while sex hormone replacement worsened the process.
Colorectal adenomas are precursor lesions of colorectal cancer. Several studies have proposed that obesity is a risk factor for colorectal adenoma. This case-control study examined the relationship between body mass index (BMI), waist circumference, waistto-hip ratio (WHR), body fat percentage and colorectal adenomatous polyps (CRA) in patients who have had a colonoscopy at the Hospital Kuala Lumpur (HKL). Fifty-nine patients (42 males and 17 females) positively identified as having CRA and 59 polypfree subjects were recruited as controls (33 males and 26 females). A pre-tested questionnaire was used to collect socio-economic information, while anthropometric measurements were determined directly by established methods. The mean BMI of female case subjects was significantly higher than control females (25.63 + 4.87 kg/m2 vs. 23.86 + 3.70 kg/m2, p<0.05) but the difference in BMI was not significant in men. The mean WHR of male subjects was significantly higher in the case group (0.92 + 0.07 vs. 0.90 + 0.06, p<0.05). After adjusting for confounders, waist circumference was the only indicator that was found to significantly increase the risk for CRA in women (OR = 6.349, 95% CI = 1.063 - 37.919). Higher BMI, WHR and body fat percentage showed a non-significant risk in female subjects. In men, none of the obesity indicators were found to be significant risk factors for CRA. These findings suggest that abdominal obesity may be a contributing factor to CRA risk particularly in women. A prospective study is needed to confirm the role of obesity in the development of CRA in Malaysians.
Maple syrup urine disease (MSUD) is an inherited metabolic disorder characterised by a severe, usually lethal, neonatal course unless dietary intake of branched chain amino acids is restricted. We describe a patient with MSUD who had computed tomography (CT) changes of diffuse white matter hypodensity, particularly in the deep white cerebellar matter, brain stem, cerebral peduncles, thalamus and posterior limb of the internal capsule. With dietary treatment, there was neurological improvement with simultaneous disappearance of the oedema. These CT changes are typical of MSUD, hence are relevant findings in the neuroradiologic differential diagnosis of a possible metabolic disorder.