A young adult community health advisor-led intervention to increase colorectal cancer screening uptake among South Asians: A feasibility study

Objective

The present study explored the feasibility and acceptability of a young adult community health advisor (YACHA)-led intervention among South Asians aged between 50 and 75 years in Hong Kong.

Methods

A pilot randomized controlled trial was conducted from July to November 2022. Thirty-six eligible participants were randomized to either the YACHA-led intervention (n ​= ​19) or the control group (n ​= ​17). The study outcomes were measured at baseline and 4 weeks after baseline.

Results

A total of 36 eligible South Asian participants with a mean age of 56.00 years (SD ​= ​5.53) participated in the study. The consent rate was 100.0%, and the overall dropout rate among the participants was 11.1%. The proposed YACHA-led intervention components were implemented as planned with the intended modality and frequency. More than 90% of the participants showed the acceptance of and satisfaction with a YACHA-led intervention that they received during the month-long process of undergoing colorectal cancer screening.

Conclusions

The present study revealed that it was feasible to conduct a YACHA-led intervention to increase the utlization of colorectal cancer screening by eligible South Asians in Hong Kong. A full-scale study should be conducted to reveal its effects and to explore whether the participants would continue their participation in the colorectal cancer screening program and be screened for colorectal cancer annually or biannually, as recommended by the Hong Kong government.

Trial registration

This study was registered with the Chinese Clinical Trial Registry (ChiCTR2200058241).

Achieving equitable access to cancer screening services to reduce the cancer burden in the Asia-Pacific region: Experience from Hong Kong

The global burden of cancer can be reduced through early detection by providing people with unrestricted access to cancer screening services. However, health disparities exist within and across countries and regions. This viewpoint article uses the Integrative Multicomponent Programme for Promoting South Asians' Cancer Screening Uptake (IMPACT) project as an example of sharing strategies, such as evidence-based multimedia interventions, community health worker-led interventions, strengthening relationships and building networks, that are being adopted to improve ethnic minorities' access to cancer screening services in Hong Kong. We find that the IMPACT project effectively increased South Asians' cancer screening uptake (e.g. the cervical cancer screening uptake rate saw a 42% increase over 5 years). Future directions for scaling up the IMPACT project have been suggested to contribute to achieving Goal 3 in the United Nations Sustainable Development Goals by 2030, that is, ensuring healthy lives and promoting the well-being of all people at all ages.

Fibroadenoma of Ectopic Breast Tissue in the Groin – A Rare Disease Entity

Introduction/Objective

Ectopic breast tissue (EBT) is a well-documented anomaly of the breast and commonly presents along the embryonic milk line extending between the axilla and groin. Reported incidence of accessory breast is 0.4–6% in females. Pathologies developing in an EBT are reported as a rare entity in the literature.

Carcinoma is reported as the common pathology followed by inflammation and fibroadenoma

Methods

We present a case of 43-year- old female who presented with a painless mass in her right groin for the past year which gradually increased in size. CT abdomen pelvis with contrast showed a 2.2 x 3.0 x 4.4 cm superficial soft tissue mass in the right groin which was suspected to be a lymph node. Further investigation and histopathological report of biopsy showed ectopic breast tissue with admixed chronic inflammation and reactive changes.However, excision of the mass three months later showed showed proloferation of both glandular and stromal elements.

Results

The tissue from the biopsy was positive for GATA 3, mammoglobin, GCDFP and CD 10 and the histological features on excision was confirmatory of fibroadenoma.

Conclusion

In conclusion, when tumors or nodules are found along the mammary line, the presence of breast tissue should be considered during the investigation. It is clinically wise to evaluate and screen carefully cases of supernumerary breast for any pathology and for any associated urogenital anomalies such as supernumerary kidneys, polycystic kidneys and renal cell adenocaricnoma. In our case, patient had no associated urogenital anomalies and she is on follow up.

A Rare Presentation of Pseudomembranous Colitis in a COVID-19 patient

Introduction/Objective

Recent reports suggest that though COVID-19 is predominantly a respiratory pathogen, one of its presenting features can be gastrointestinal symptoms. We hereby present a case of a female with COVID-19 infection whose hospital course was complicated by colonic pseudo-obstruction caused by pseudomembranous colitis resulting in an emergent hemicolectomy.

Methods

A 59-Year-old female with history of hypertension, diabetes, and breast cancer post mastectomy presented with pneumonia and was confirmed to be COVID-19 positive. She was admitted to the hospital and was treated with Azithromycin for 6 days. Patient developed constipation on day six of hospitalization and started having abdominal pain on day eight with elevated WBC count. Imaging showed distension of cecum and proximal colon. She underwent exploratory laparotomy which revealed a necrotic appearing cecum that was massively dilated and had a serosal tear. These findings prompted emergent hemicolectomy with loop ileostomy. Grossly cecum was black/green, dilated, thin walled with a 5 x 5 cm yellow green raised plaques. Microscopy of the plaques revealed focal erosion of colonic mucosa with overlying acute inflammatory cells, fibrin deposits, mucus, and necrotic epithelial cells consistent with pseudomembranous colitis.

Conclusion

Review of literature shows no reported cases of intestinal pseudo-obstruction due to pseudomembranous colitis in a COVID-19 patient. Not only this, but there are also only a limited number of case studies of pseudomembranous colitis presenting as intestinal pseudo-obstruction without diarrhea. Though this patient’s presentation could be from Clostridium difficile infection secondary to Azithromycin, it is not a common antibiotic to cause this. Also, one of the known causes of pseudomembranous colitis is ischemia. Given that COVID-19 infection is a pro-thrombotic condition, possible ischemia secondary to COVID-19 infection related coagulopathy should also be a consideration.

Knowledge Level and Hand Hygiene Practice of Nepalese Immigrants and Their Host Country Population: A Comparative Study

Nepali people are one of the ethnic minority immigrants of Hong Kong. This epidemiological investigation aims to determine and compare the knowledge level and hand hygiene (HH) behaviour of the Nepali people and the population of their host country (i.e., native Chinese population of Hong Kong). A total of 1008 questionnaires were collected via an online platform. The overall knowledge level of the native population towards HH was considerably higher than that of the Nepali respondents. Lower levels of knowledge in young and older people were noted. Reduced HH knowledge was also observed in people with low educational level or with comorbid illness(es). Significant differences between groups were noted in the self-reported hand washing behaviours. Regarding hand drying, more Nepalese than native Chinese respondents always/sometimes dried their hands on their clothing irrespective whether after performing handwashing in public washrooms or at home. Misconceptions and suboptimal practices on HH were prevalent in the two populations. The findings of this comparative study offer valuable information for the development of culturally sensitive health educational programs to enhance HH practices for the ethnic minorities and native Chinese population.

A community health worker-led multimedia intervention to increase cervical cancer screening uptake among South Asian women: study protocol for a cluster randomized wait-list controlled trial

Background

Marked ethnic disparities on cervical cancer screening have been observed among South Asian women. Multiple barriers, such as language difficulties, poor access to screening services, values, and beliefs, were identified. Multimedia interventions led by community health workers (CHWs) would likely reduce screening disparities and increase cervical screening uptake among South Asian women. This study aims to assess the effects of a CHW-led multimedia intervention on the uptake of cervical cancer screening among South Asian women.

Methods

This study is a cluster randomized wait-list controlled trial. A total of 408 South Asian women from Pakistan, India or Nepal will be recruited from six ethnic minority associations. Each association will be randomized to one of the two arms: an intervention arm (n = 3) that will undergo immediate treatment (CHW-led multimedia intervention) or a wait-list control arm (n = 3) that will receive delayed treatment. Each recruited CHW will be allocated to either arm according to the association she is affiliated with. The intervention arm will receive a CHW-led intervention comprising two components: multimedia education, and monthly telephone follow-up and navigation assistance. Participants in the control arm (n = 3) will be offered the CHW-led intervention after those in the intervention arm have completed the intervention. The primary outcome measure is the uptake of cervical cancer screening. Secondary outcomes include readiness to undergo screening and beliefs regarding cervical cancer screening. Outcomes assessments will be performed at baseline, immediately after, and 3 months after completion of the intervention.

Discussion

The results of this study will potentially provide significant practical implications for addressing the needs and increasing the uptake of cervical cancer screening among South Asian women.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1800017227. Registered on 18 July 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3378-4) contains supplementary material, which is available to authorized users.

Development and Evaluation of Multimedia Interventions to Promote Breast and Cervical Health among South Asian Women in Hong Kong: A Project Protocol

Recent studies conducted in the local community indicate that the uptake rates of breast and cervical cancer screening among South Asian ethnic minorities are lower than those of the general population. The development of interventions to promote these minorities' awareness of breast and cervical health and the importance of cancer screening is therefore required. This study protocol aims to develop culturally sensitive multimedia interventions to promote awareness of breast and cervical cancer prevention among South Asian women in Hong Kong, and to evaluate the outcomes of such interventions using a Reach-Effectiveness-Adoption-Implementation-Maintenance framework. By using a multimedia approach and developing socio-culturally relevant and linguistically appropriate educational materials, information related to cancer and accessible preventive measures for breast and cervical cancer is expected to be disseminated more effectively among South Asian women and ultimately increase their awareness of engaging in healthy lifestyles and taking part in cancer screening tests. Successful engagement of community partners will enhance the future sustainability of the project.

Infant and young child feeding practices in Chepang communities

BACKGROUND

Infant and young child feeding (IYCF) practices differ in communities due to difference in knowledge, culture, health service utilization, and other socio-economic factors. The objective of this study was to explore the knowledge and practices of Chepang mothers on ICYF and their correlates.

METHODS

Cross sectional descriptive study was conducted in Chepang communities of Makawanpur district. Quantitative methodology was used in which 360 mothers of under children under two were randomly selected. Logistic regression analysis of selected child feeding indicators were done to find their association with socio-economic and health related factors.

RESULTS

Feeding practices of mothers were found better than their knowledge level. About 35% had knowledge about early initiation of breastfeeding. Exclusive breastfeeding and introduction of complementary foods at the age of six months were 81% and 90% respectively. Literate mothers were found initiating breastfeeding early than the illiterate (OR=2.61, 95% CI, 1.59-4.27). Growth monitoring service utilization was found to have significant association with exclusive breastfeeding practices (OR= 2.75; 95% CI, 1.30-5.78). Feeding diverse complementary foods was associated with average monthly family income and duration of food sufficiency.

CONCLUSIONS

Feeding practices in Chepang community were associated with health and socioeconomic determinants. Some of the feeding practices were found good however, meal frequency for the children 9-23 months of age and feeding diverse foods for children 6-23 months were found lower which needs to be improved through health education programs. Qualitative studies are needed to explore cultural factors.

Molecular characterization of antigen B2 subunit in two genotypes of Echinococcus granulosus from Indian bubaline isolates, its stage specific expression and serological evaluation

Echinococcus granulosus is a parasitic helminth which affects both man and animals. During infection with larval stage of the organism secretory and membrane-bound (S/M) proteins play a meaningful role for evasion of immune system. Antigen B (AgB) is one of them. Present investigation has defined sequence diversity of AgB2 subunit of cattle and buffalo isolates of the organism. A total of 55 isolates were screened by polymerase chain reaction based single stranded conformation polymorphism (PCR-SSCP). Subsequently, six conformers could be detected. Based on predicted amino acid sequences of 90 amino acid residues, three clusters could be deduced. Sequence information of two buffalo isolates was homologous to AgB4 indicating gene switching phenomenon in between closely related isoforms. Numerical value of Tajima's D test proved negative selection pressure. Using artificial neural network (ANN), B cell linear epitope and stretches of agretope were predicted. Three clusters could be defined on the basis of B cell linear epitope. Out of three clusters, two showed more than 50% binding propensity with same MHCII alleles whereas, cluster 3 exhibited binding propensity with other MHCII alleles (DRB1_1501, DRB1_1502). Relative expression of AgB2 was more in active cysts (1.636 ± 0.092) followed by degenerating (0.449 ± 0.037) and calcified (0.255 ± 0.008). This result suggested that relative expression of AgB2 declines with progression of the disease. Using recombinant AgB2 sensitivity, specificity and accuracy of the ELISA test was 96.7, 94.7 and 95.9%, respectively. No cross reactivity was found with common cestode and trematode infected cattle and buffalo because cross reactive antigen was expressed intracellularly. Finally, this was concluded that AgB2 is the suitable immunological marker for detection, diagnosis and progression of the disease.

Use of zinc chloride as alternative stimulant for in vitro study of nitric oxide production pathway in avian splenocyte culture

Nitric Oxide (NO) plays an important role for regulation of cellular and vascular response of inflammation and initiates killing mechanism in the host-defense reactions. NO production is regulated through inducible nitric oxide synthase (iNOS) pathway in response to infections and injurious agents besides pro-inflammatory cytokines secreted by the host. Evaluation of NO pathway is one of the major targets which can evaluate various immunomodulators for their therapeutic interaction on innate immune system. Lipopolysaccharide (LPS) and concavalin A (ConA) are used as standard mitogen for peripheral blood mononuclear cells and splenocyte of mammalian and avian cell culture. During the present investigation ZnCl(2) has been explored as standard mitogen and result was comparable with standard mitogen. The result has been evaluated on the basis of relative mRNA expression of iNOS and interferon gamma and nitrite assay. Observation indicated significantly higher expression of both biomolecules in comparison to control, LPS, ConA treated group. This study indicated that, ZnCl(2) can also be used as standard stimulant for molecular mining of innate immunity.

Survey of psychiatrists' views of nurse prescribing

For mental health nurses and service users to realize the benefits of non-medical prescribing, psychiatrists need to understand the remit of this role and be actively involved in influencing it. Although healthcare policy in the UK supports the expansion of non-medical prescribing, it requires much more for the successful implementation of such initiatives in practice. The aim of this survey was to explore the attitudes of all grades of psychiatrist working in two mental health trusts in the West Midlands to nurse prescribing. A specifically designed questionnaire was sent out to two groups of psychiatrists to assess their attitudes towards non-medical prescribing. Psychiatrists (n = 147) completed and returned a specifically designed questionnaire of their views. The more senior doctors appeared less concerned about nurse prescribing. Junior doctors expressed equivocation towards the role, suggesting that nurse prescribers be consistently supervised and have limited access to mental health drugs. The findings from this study have considerable implications for teams if junior doctors hold different views to their senior colleagues. Without the assistance of trusts in facilitating role change, the introduction of new roles could potentially heighten conflict between professions.

Mycobacterial infections in human immuno-deficiency virus seropositive patients: role of non-tuberculous mycobacteria

BACKGROUND

There is high prevalence of tuberculosis in patients with HIV infection; hence the role of non-tuberculous mycobacteria (NTM) in HIV patients has always been undermined. NTM may be responsible for clinical disease in a substantial number of immuno-compromised HIV sero-positive individuals even in a country endemic for Mycobacterium tuberculosis (M. tuberculosis). The study was designed to look for the contribution of NTM to morbidity in HIV seropositive patients.

MATERIAL AND METHODS

In a prospective study of ninety-four HIV seropositive individuals presenting with pulmonary or extra-pulmonary symptoms suggestive of mycobacterial infection, appropriate samples were collected and processed. Detailed clinical history was utilized to differentiate colonization or contamination by NTM from true lung disease.

RESULTS

Fourteen samples grew mycobacterial species, 8(57.2%) being NTM. The distribution of NTM was--3 M. avium complex, 2 M. fortuitum, 2 M. vaccae, 1 M. phlei. 6 isolates were M. tuberculosis.

CONCLUSION

NTM may be responsible for a significant proportion of mycobacterial infections in HIV seropositive individuals. Despite the high endemicity of tuberculosis in developing countries like India, the presence of NTM should be ruled out; especially in immuno-compromised HIV seropositive individuals before instituting anti-tubercular therapy empirically. In addition, non-response of NTM to ATT may be wrongly attributed to multi-drug resistant tuberculosis.

Wild Himalayan Cherry (Prunus cerasoides) as a Natural Host of Prunus necrotic ringspot virus in India

Prunus cerasoides, also known as wild Himalayan cherry, grows naturally in the Himalayas. A member of the Rosaceae family, the tree has medicinal (astringent) and other (beads, dye, wood) uses. During surveys in the northwestern Himalayan Region of India, necrotic spots were observed on leaves of P. cerasoides. Since the symptoms were typical of Prunus necrotic ringspot virus (PNRSV), preliminary detection was done by double-antibody sandwich (DAS)-ELISA (Agdia, Elkhart, IN). Positive results were obtained three times more than the negative control which is provided in the kit. To further confirm its presence, reverse transcription (RT)-PCR analysis was performed using a primer pair (upstream 5'-AACTGCAGATGGTTTGCCGAATTTGCAA-3'; downstream 5'-GCTCTAGACTAGATCTCAAGCAGGTC-3') specific for the coat protein gene (GenBank Accession Nos. AJ619984 and AJ619983). Amplification of the expected 675-bp fragment was obtained. The sequence of a cloned copy of the amplified product showed 99% similarity to the PNRSV coat protein gene (GenBank Accession No. AF170165), confirming the presence of PNRSV in P. cerasoides (sequence submitted as Accession No. AM493717). The cloned DNA has the potential for utilization as an additional tool, and an early PNRSV screening (both pollen and seed transmitted) will be highly useful to ensure healthy rootstocks are used for grafting purposes (1). PNRSV mainly infects members of the Rosaceae family, including stone fruits and ornamental plants such as peach, plum, cherry, apricot, nectarines, and roses, and was first reported in P. persica (1). Proper management of PNRSV at this level can prevent its transmission and disease development in grafted scions of commercial Prunus spp. Reference: (1) A. A. Brunt et al. Page 1047 in: Viruses of Plants. CAB International, Wallingford, UK. 1996.

The role of matrix metalloproteinases in ulcerative keratolysis associated with perioperative diclofenac use

OBJECTIVE

To investigate the role of matrix metalloproteinases (MMPs) in the pathogenesis of ulcerative keratolysis associated with topical use of generic diclofenac preoperatively and postoperatively. To characterize the inflammatory response of the cornea in this case of ulcerative keratolysis.

DESIGN

Case report with clinicopathologic correlation.

MAIN OUTCOME MEASURES

Corneal culture for microbial growth. Clinical and histopathologic examinations including routine histolopathologic, immunofluorescent, and immunohistochemical studies.

RESULTS

Microscopic examination of the corneal button disclosed fibrinous material with neutrophils and mononuclear inflammatory cells. The corneal epithelial basement membrane was irregularly thickened and patchy. Immunohistochemical staining detected weak staining of MMP-1 and a strong presence of MMP-8 in the epithelium. MMP-8 and 9 were also present in areas of leukocytic infiltration. MMP-2 appeared in a few stromal cells. Macrophages and leukocytes were the predominant infiltrating cells.

CONCLUSIONS

A nonspecific inflammatory response occurred in this case of ulcerative keratolysis. Corneal epithelial cells are capable of secreting MMP-1 and 8 and may participate in the stromal degradation and repair process of the ulcerative keratolysis associated with topical nonsteroidol antiinflammatory use.

Therapeutic irradiation for patients with an elevated post-prostatectomy prostate specific antigen level

PURPOSE

This study was initiated to determine the efficacy of post-prostatectomy therapeutic radiation for patients with elevated prostate specific antigen (PSA).

MATERIALS AND METHODS

A total of 47 patients received 66 Gy. therapeutic irradiation to the prostate bed for a PSA level greater than 0 ng./ml. postoperatively. Univariate and multivariate survival analyses were performed to identify prognostic variables.

RESULTS

At a median followup of 36 months (range 18 to 48) 83 and 33% of the patients with PSA 2 ng./ml. or less and 2 ng./ml. or greater, respectively, had no evidence of disease (p = 0.001). Pathological stage and a complete biochemical response (PSA less than 0.05 ng./ml.) were also significant prognostic variables.

CONCLUSIONS

Therapeutic irradiation for patients with elevated PSA postoperatively is highly effective. At a median followup of 36 months 64% of the patients remain disease-free.

Effects of gonadotrophin treatment in vivo on testicular function in immature rhesus monkeys (Macaca mulatta)

Changes in testicular histology and concentrations of testosterone and oestradiol 17 beta in testicular tissue and plasma have been studied following administration of gonadotrophins (oFSH, oLH, hCG and PMSG) to immature male monkeys. Treatment with FSH (1 mg/day) or PMSG (100 IU/day) for five days, induced a marked enlargement of the seminiferous tubules and increase in the Sertoli cell cytoplasm. Injections of LH (1 mg/daily) or hCG (100 IU/daily) administered similarly, failed to produce hypertrophy of the Sertoli cell. In LH, hCG and PMSG stimulated testes morphologically differentiated interstitial cells could be recognized. FSH did not produce any detectable effect on the intertubular tissue. A significant increase in testicular and plasma testosterone levels was observed with LH, hCG and PMSG. FSH was shown to be much less effective in stimulating androgenesis. An increase in testicular oestradiol production over that of controls, was observed in FSH and PMSG treated monkeys but not in animals treated with LH or hCG.