Effect of Nutritional Formula on Fatigue Among Patients With Advanced Lung Cancer at a University Hospital-Egypt.

Background: Lung cancer is the most common cancer and cause of death worldwide. Almost 50 percent of lung cancer cases are found in the developing countries. The estimated numbers of new lung cancer cases in the Arab world show a gradual increase every year. Cancer lung and its treatment modalities increase incidence of fatigue. Many studied documented that patients with cancer related fatigue described it as more distressing than other cancer-related symptoms such as pain, depression, and nausea. Correction of anemia, exercises, dietary supplements rich in vitamins specially beta-carotene, yoga, complementary and alternative medicine have been suggested as strategies/ guidelines of managing fatigue. Natural nutritional supplementations were recommended by oncologists, nurse specialists, as well authors in the field of applied nutrition and they recommend juicing fruits and vegetables. One of the recommended formulas for fighting fatigue consisted of carrot, beetroot, mixed with celery juice (energy juice). Carrot juice is known as a miracle juice as it removes bacterial infection, beetroot act as anti cancer factor as well as powerful blood detoxifying agent and celery juice is a source of folic acid, vitamin B1&6. Aim of the Study: Was to identify the effect of the nutritional formula on fatigue among lung cancer patients at a University Hospital-Egypt. Design: Time series longitudinal comparative study. Research questions: 1-a-What is the effect of the nutritional formula on fatigue among patients with advanced lung cancer before and after receiving chemotherapy? 1-b- Is there a difference between fatigue scores on the start of using the formula and at the end of rehydration period among patients with advanced cancer lung receiving chemotherapy? 2-a-Is there a relation between fatigue score prior and after taking the nutritional formula and the selected medical outcome (duration of illness, hemoglobin, WBCs)? 2-b-Is there a relation between fatigue score prior and after taking the nutritional formula and patients' age, metastasis occurrence and chemotherapy medication? Sample: A convenient sample of thirty patients with advanced lung cancer receiving chemotherapy was collected over a year. Two tools were used to collect data; Demographic & Medical data assessment sheet and the Revised Piper Fatigue Scale (PFS-R13).  Data were collected before receiving chemotherapy (on admission), one day after receiving chemotherapy (beginning of using the nutritional formula), after rehydration period (one week later), two weeks later & before discharge). Results: Fatigue scores increased after receiving chemotherapy and began to decrease gradually after rehydration period, so there was a significant statistical difference between fatigue scores measured before and after the use of the nutritional formula. And there is a statistical significant difference over the four readings of fatigue scores reading and the selected medical responses (duration of illness Hgb 1st reading & 2nd reading, WBCs 1st reading), age. Conclusion: The suggested nutritional formula helped in decreasing fatigue among lung cancer patients receiving chemotherapy. Key words: Fatigue, cancer lung, chemotherapy, nutritional values (Carrots, celery, parsley)

Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective

Background: Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt’s health care context. Methods: The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. Discussion: The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis–Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research