Physical and psychosocial quality of life in children with overweight and obesity from Sri Lanka

Background

While childhood obesity is rising rapidly in South Asia, there is limited research on quality of life (QoL) of children with overweight and obesity from the region. This study assessed physical and psychosocial QoL in Sri Lankan children attending a specialized obesity clinic, from both children’s and parents’ perspective, and modifiable social factors affecting QoL.

Methods

We performed cross-cultural translation of the Pediatric Quality of Life Inventory (PedsQL™) 4.0 (Child-Self Report and Parent-Proxy forms), and assessed self-reported and parental-perception of physical and psychosocial QoL in 8–12 year-olds with overweight and obesity (n=110), referred for obesity management at a tertiary-care children’s hospital in Sri-Lanka. Body mass index (BMI) and pre-selected social factors affecting QoL were also assessed. Data were analyzed by non-parametric tests (Mann-Whitney U test, Wilcoxon test and Spearman correlation).

Results

The median physical QoL was lower than psychosocial QoL (78.1vs81.7, p=0.032) and physical QoL was inversely correlated with BMI. Parental-perception of children’s physical and psychosocial QoL correlated with child-reported QoL, but was lower. Being bullied (p=0.001) and not getting regular exercise (p=0.031) were associated with lower psychosocial QoL. Both physical and psychosocial QoL were lower in children having difficulties in finding suitable clothes (p< 0.001).

Conclusions

Children with overweight and obesity from Sri Lanka appeared to have greater impairment of physical QoL than psychosocial QoL. Higher BMI, bullying, lack of regular exercise and lack of suitable clothing, negatively affected QoL. Potential strategies to improve QoL include promoting regular exercise, addressing bullying and promoting availability of children’s clothes in larger sizes to fit children with overweight and obesity.

P6187Multicentre diagnostic performance of on-site workstation CT derived fractional flow reserve

Background

On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess vessel specific ischaemia in coronary artery disease (CAD). Global data on its diagnostic performance when compared with CT coronary angiography (CTA) is limited.

Purpose

To evaluate the on-site multicentre diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia.

Method

This is a retrospective pooled analysis of 141 patients (204 vessels) with suspected CAD enrolled from 3 global centres who underwent CTA, onsite CT-FFR and invasive FFR. On-site CT-FFR was performed using a reduced order model on a standard desktop computer with dedicated software. The per vessel diagnostic performance of CT-FFR (≤0.8) for vessel specific ischemia (FFR≤0.8) was compared with CTA (≥50% stenosis).

Results

Mean age was 65.8±9.9, 70.7% were male. FFR significant stenosis was present in 34.3% (70/204) of vessels. Pearson correlation of CT-FFR for invasive FFR was 0.52, P<0.001. Bland Altman analysis demonstrated a mean difference of 0.06±0.15 (95% limits of agreement −0.22 to 0.35). Per vessel diagnostic accuracy, sensitivity and specificity of CT-FFR and CTA were 79.9% vs 53.5%; 78.6% vs 85.7%; 80.6% vs 35.9% respectively. Diagnostic performance as assessed by area under the receiver operator curve (AUC) for CT FFR was superior to CTA (0.82 [95% CI 0.76–0.88] vs 0.61 [0.55–0.67]; P<0.001).

Conclusion

On-site workstation CT-FFR demonstrated high per vessel diagnostic performance and was superior when compared with CTA in assessment of vessel specific ischaemia as assessed by invasive FFR in a multicentre setting.

Abstract P4-21-28: Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer

Introduction

HER2 status has been routinely ascertained for stage I-III breast cancer since late 2005. Trastuzumab was first funded in New Zealand for use in HER2+ breast cancer in July 2007. This observational study aims to compare the difference in outcome between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did not. Differences in presentation, treatment and outcomes between Māori and NZ European were studied.

Methods

The combined Waikato and Auckland Breast Cancer Registries have clinical details of 12377 women diagnosed with breast cancer between June 2000 and May 2013. 9506 women with breast cancer were tested for HER2 receptor status. Proportion of women with HER2+ (FISH amplified or IHC 3+), stage I-III breast cancer were examined by age, ethnicity and stage. Differences in use of trastuzumab for women with stage I-III breast cancer with a tumour size equal or larger than 1 cm and aged less than 75 years were assessed by ethnicity and year of diagnosis. Patients who had inflammatory breast cancer or developed metastatic disease or local recurrence within 3 months after diagnosis were excluded. Kaplan-Meier method and Cox proportional hazards model were used to examine the breast cancer-specific survival between women treated with trastuzumab and chemotherapy and those treated with chemotherapy without trastuzumab.

Results

1454 patients with early invasive breast cancer were HER2+. The proportion of cases with HER2+, stage I-III breast cancer increased with stage (stage I-III: 11.5%-26.9%), but decreased with age (&lt;40 years to 80+ years: 28.8%-9.7%). Māori women were more likely to have HER2+ cancers than NZ European (17.8% versus 14.9%; p=0.02). Among the eligible patients, 605 women received trastuzumab and chemotherapy within 12 months for stage I-III breast cancer, and 275 had chemotherapy without trastuzumab. A small proportion (10.2%, 34/333) of women diagnosed in 2000-2005 received trastuzumab as part of a clinical trial. The proportion of women who received trastuzumab increased to 60.3% in 2006-2009 and to 87.1% in 2010-2013. 46.2% of Māori women were treated with trastuzumab compared to 55.9% of NZ European (p=0.040). The cancer-specific survival estimated with Kaplan-Meier method is shown in Table 1. Women treated with chemotherapy without trastuzumab were 2.7 times (95% CI: 1.9-3.9) more likely to die of breast cancer compared to those treated with trastuzumab and chemotherapy, after adjustment for stage, tumour size and hormone therapy.

Table 1. Breast cancer-specific survival between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did notTreatmentNumber of patientsMedian follow-up time (months)5-year survival10-year survivalTrastuzumab+chemotherapy6055389.6%84.3%Chemotherapy without trastuzumab27510775.6%69.1%

Conclusions

Trastuzumab improved the breast cancer-specific survival of women with HER2+ stage I-III breast cancer. Māori women were more likely to have HER2+ cancer and less likely to be treated with trastuzumab. Rates of treatment with trastuzumab and the adjusted survival between Māori women and NZ European women were not significantly different.

Citation Format: Lawrenson R, Lao C, Harvey V, Campbell I, Brown C, Seneviratne S, Edwards M, Scott N, Elwood M, Sarfati D, Kuper-Hommel M. Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-28.

Hereditary hemorrhagic telangiectasia, liver disease and elevated serum testosterone (Osler-Weber-Rendu syndrome): a case report

Background

A Sri Lankan girl with hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome) is described.

Case presentation

She presented with recurrent spontaneous epistaxis, pulmonary arterio venous malformation and oral telangiectasia. A diagnosis of Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome) was made based on the presence of three Curacao criteria (out of four). Evaluations of her jaundice revealed chronic parenchymal liver disease with multiple nodules in the liver with early portal hypertension. She had a muscular build, with elevated serum testosterone but low serum dehydroepiandrosterone sulphate levels. This could be attributed to impaired sulfation of dehydroepiandrosterone due to portocaval shunting of blood, leading to hyperandrogenemia.

Conclusions

Hyperandorogenemia due impaired sulfation of dehydroepiandrosterone as a result of portocaval shunting is seen in Hereditary haemorrhagic telangiectasia.

Lack of Evidence of Pathogenetic Role of Epstein-Barr Virus in Thymic Lymphoid Hyperplasia and Thymomas in the Chinese Population of Hong Kong

A previous study from Hong Kong by McGuire et al. reported frequent demonstration of Epstein-Barr virus (EBV) DNA by Southern blot analysis in thymoma, thymic lymphoepithelioma-like carcinoma, and thymic lymphoid hyperplasia. This provoca tive finding, however, could not be confirmed by studies in the Western populations using the Southern blot technique and/or polymerase chain reaction to detect EBV- DNA or in situ hybridization to detect EBV encoded RNA (EBER), raising the possibility that the association with EBV may be restricted to Asians. This study was performed to clarify this issue by using a highly sensitive localization technique for EBER on a larger series from the Asian population of Hong Kong. Paraffin sections obtained from 10 cases of thymic lymphoid hyperplasia, 42 noninvasive thymomas (including one case previously reported to be EBV positive), 11 invasive thymomas, and 9 thymic carcinomas (including 5 cases of lymphoepithelioma-like carcinoma) were studied. EBER signal was not detected in the epithelial cells in any of the cases except for two cases of lymphoepithelioma-like carcinoma. In two thymomas, a few small lympho cytes (<0.1%) were EBER positive. Failure to detect EBER was not an artifact due to RNA denaturation, because preserved mRNA could be demonstrated by oligo-dT labelling in 56 of the 72 cases. Thus, the results of this study on Hong Kong Chinese are in keeping with those reported in Caucasians, and more recently in Japanese and Taiwan Chinese, in that there is no association of EBV with thymic lymphoid hyperpla sia or thymoma, and that EBV may be demonstrated in a proportion of thymic lymph oepithelioma-like carcinomas. The positive results previously reported cannot be ex plained, because the occasional EBV-carrying lymphocytes detected in rare cases of thymoma should be insufficient to give a positive EBV result by Southern blot tech nique. Int J Surg Pathol 2(1):17-22, 1994

C1 inhibitor deficiency: 2014 United Kingdom consensus document

C1 inhibitor deficiency is a rare disorder manifesting with recurrent attacks of disabling and potentially life-threatening angioedema. Here we present an updated 2014 United Kingdom consensus document for the management of C1 inhibitor-deficient patients, representing a joint venture between the United Kingdom Primary Immunodeficiency Network and Hereditary Angioedema UK. To develop the consensus, we assembled a multi-disciplinary steering group of clinicians, nurses and a patient representative. This steering group first met in 2012, developing a total of 48 recommendations across 11 themes. The statements were distributed to relevant clinicians and a representative group of patients to be scored for agreement on a Likert scale. All 48 statements achieved a high degree of consensus, indicating strong alignment of opinion. The recommendations have evolved significantly since the 2005 document, with particularly notable developments including an improved evidence base to guide dosing and indications for acute treatment, greater emphasis on home therapy for acute attacks and a strong focus on service organization.

IgE recognition patterns in peanut allergy are age dependent: perspectives of the EuroPrevall study

BACKGROUND

We tested the hypothesis that specific molecular sensitization patterns correlate with the clinical data/manifestation in a European peanut-allergic population characterized under a common protocol.

METHODS

Sixty-eight peanut-allergic subjects and 82 tolerant controls from 11 European countries were included. Allergy to peanut and lowest symptom-eliciting dose was established by double-blind placebo-controlled food challenge in all but anaphylactic subjects. Information of early or late (before or after 14 years of age) onset of peanut allergy was obtained from standardized questionnaires. IgE to peanut allergens rAra h 1-3, 6, 8-9, profilin and CCD was determined using ImmunoCAP.

RESULTS

Seventy-eight percent of peanut allergics were sensitized to peanut extract and 90% to at least one peanut component. rAra h 2 was the sole major allergen for the peanut-allergic population. Geographical differences were observed for rAra h 8 and rAra h 9, which were major allergens for central/western and southern Europeans, respectively. Sensitization to rAra h 1 and 2 was exclusively observed in early-onset peanut allergy. Peanut-tolerant subjects were frequently sensitized to rAra h 8 or 9 but not to storage proteins. Sensitization to Ara h 2 ≥ 1.0 kUA /l conferred a 97% probability for a systemic reaction (P = 0.0002). Logistic regression revealed a significant influence of peanut extract sensitization and region on the occurrence of systemic reactions (P = 0.0185 and P = 0.0436, respectively).

CONCLUSION

Sensitization to Ara h 1, 2 and 3 is usually acquired in childhood. IgE to Ara h 2 ≥ 1.0 kUA /l is significantly associated with the development of systemic reactions to peanut.