The socio-demographic and clinical factors associated with quality of life among patients with brain pathology in a tertiary referral hospital in Malaysia

Background: This paper investigates the quality of life of brain pathology patients in relation to their socio-demographic profiles and clinical factors. Methods: This is a cross-sectional study done at a tertiary referral hospital in Kuala Lumpur. A total of 100 patients were recruited in the study after excluding 22 patients who did not met the exclusion criteria. The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) self-administered questionnaire was utilized in the study. The Global health status/QoL, Physical functioning, Role functioning, Emotional functioning, Cognitive functioning, Social functioning, Fatigue, Nausea and vomiting, Pain, Dyspnoea, Insomnia, Appetite loss, Constipation, Diarrhoea, and Financial difficulties were assessed in this study. Results: The most severe impairment in functioning was with lowest score of cognitive functioning (mean score=61) and the most severe symptom was fatigue (mean score=45). There were significant differences in quality of life scores in different socio-demographic groupsand types of brain pathology patients. Patients aged below 40 years old or less had better physical functioning, less symptoms of fatigue and insomnia compared to patients who were more than 40 years old. Male patients faced more financial difficulties compared with female patients. Patients who were married had increased insomnia compared to the single patients. Employed patients had better physical functioning and less financial difficulties compared with patients who were unemployed. Patients who earned >RM 2500.00 monthly had better physical functioning, less symptoms of pain and less financial difficulties than patients who earned ≤RM 2500.00. Patients with qualifications lower than SPM tended to face more financial difficulties compared to patients with qualifications of SPM or higher. Meningioma patients had better social functioning compared with others, whereas Carvenoma patients had better physical functioning. Meningioma patients had more symptoms of insomnia compared with other patients. All the findings were with p value less than 0.05. Conclusion: The quality of life of patients with brain pathology is affected by socio-demographic factors and clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients

Increased endothelial progenitor cells with age and grade of malignancy in astrocytic glioma patients

Astrocytic gliomas are the most common primary brain tumours that originated from human glial cells. The tumours rely upon endothelial progenitor cells (EPCs) for neoangiogenesis. This study aimed to investigate the association between tissue resident EPCs in a brain tumour and normal adjacent tissue in relation to age and grade of astrocytic glioma. Astrocytic glioma patients (n=22), grade I to grade IV were consented from Hospital Universiti Sains Malaysia. Brain tumour tissue and normal adjacent brain tissue samples were obtained from each patient during surgery. The EPCs were stained with CD133+ and VEGFR-2+ markers. The tissue residents EPCs for each sample were determined using the immunofluorescence microscopy method. The age of the patients increased by disease severity in the following order (Grade I: 21.33±20.79 years) < (Grade II: 46.50±0.707 years) < (Grade III: 47.38±11.95 years) < (Grade IV: 48.44 ±10.66 years). The EPCs in brain tumour correlated significantly with the age of the patients with positive correlation (Spearman's rho correlation test, r=0.52; p=0.013). The tissue resident EPCs in the brain tumour (median=0.40, IqR=0.59) were significantly higher compared with the adjacent normal brain (median=0.067, IqR=0.29) (Wilcoxon Signed-Rank Test, Z stat=-3.587, p<0.001). Higher tissue resident EPCs were found in high grade (III & IV) glioma compared with EPCs in low grade (I & II) glioma (median=0.61, IqR=0.70 vs. median=0.26, IqR=0.30; z=-1.763 p=0.078). This study showed increased EPCs with age and grade of malignancy in astrocytic glioma patients. Therefore, targeting EPCs in gliomas based on tumour grade malignancy and age of the patients might be useful in effective treatment of astrocytic glioma

Quality of life among patients with brain pathology in a Malaysian hospital

The objective of this study was to determine the prevalence of symptoms and problems in Malaysian brain pathology patients. A total of 100 respondents in Kuala Lumpur Hospital were included in this cross-sectional study. The study utilized European Organization for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30). Patient with a "symptom/problem" having the minimum response of "a little". A response of "quite a bit" was defined as having a "severe symptom/problem". The two most prevalent "symptoms/problems" among the neurological disorder patients were fatigue (65%; severe: 28%) and reduced cognitive functioning (64%; severe: 25%). The mean number of "symptoms/problems" ranged from 4.63 (meningioma) to 6.80 (cerebellar edema) while the mean number of "severe symptoms/problems" ranged from 1.39 (astrocytic glioma) to 2.8 (cerebellar edema). Therefore special attention should be given to these patients in order to improve the overall quality of life of the patients

Depression and quality of life in patients with neurological disorder in a Malaysian hospital

Objective: To investigate association between major depressive disorder (MDD) and quality of life in patients with neurological disorder. Methods: This cross-sectional study was carried out at a Malaysian hospital between April 2016 and December 2016 using convenience sampling. Patients aged ≥18 years with intracranial tumour or other brain disorders were invited to participate. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire version 3.0; diagnosis of MDD was made using Mini International Neuropsychiatric Interview. Results: Of 122 patients approached, 100 (66 women and 34 men) were included (response rate, 93.5%), with a mean age of 45.3 years. The prevalence of MDD in patients with neurological disorder was 30%. Compared with non-depressed patients, patients with MDD had poorer global health status / quality of life (p = 0.003), and reduced physical (p = 0.003), role (p = 0.021), emotional (p < 0.001), cognitive (p = 0.004), and social (p = 0.007) functioning, as well as more symptoms of fatigue (p = 0.004), pain (p < 0.001), dyspnoea (p = 0.033), insomnia (p < 0.001), appetite loss (p = 0.002), constipation (p = 0.034), diarrhoea (p = 0.021), and financial difficulties (p = 0.039). Conclusion: Patients with MDD had reduced quality of life. Fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties were prevalent among patients with MDD

A Rare Case of Paediatric Pontine Glioblastoma Presenting as a Cerebellopontine Angle Otogenic Abscess

We describe rare case of a 9-year old boy who presented with a two-week history of right ear discharge and mild fever. Contrast enhanced CT scan of the brain showed a lesion in the right cerebellopontine angle with mild enhancement mimicking early abscess formation. Involvement of the mastoid air cells pointing towards a radiological diagnosis of mastoiditis reinforced the diagnosis of an abscess. A magnetic resonance imaging (MRI) was planned for the patient but his conscious level deteriorated and patient slipped into coma warranting immediate surgical intervention. Intraoperatively, about 90% of the tumour was removed and the appearance of the tumour resembled that of an acoustic schwannoma but histopathology confirmed the diagnosis of a glioblastoma multiforme (GBM). MRI done post operatively showed lesion in the pons confirming the diagnosis of an exophytic pontine glioblastoma multiforme