Relationship between skeletal muscle function, body composition, and weight loss in patients with advanced pancreatic and gastrointestinal cancers

BACKGROUND

Muscle function and its correlation with body composition and weight loss have not been studied deeply in pancreas and gastrointestinal cancers. This research aims to determine the skeletal muscle function and its relationship with body compartments, significant weight loss, and performance status (ECOG) 0-2 in a population with advanced digestive cancers.

METHODS

A cross-sectional study was designed to determine the relationship between muscular function, weight loss, and body composition. Patients with advanced digestive adenocarcinomas were evaluated. Muscle strength was examined by hand grip technique and body composition by bioimpedance analysis. Values of hemoglobin and albumin were measured in plasma.

RESULTS

A sample of 81 patients was included. They had adenocarcinoma of stomach (n = 9), pancreas (n = 28), or colorectum (n = 44). With regard to skeletal muscle function, sub-maximal strength increased when percentage of weight loss decreased (p = 0.002) or when any of the following variables increased: skeletal muscle (p < 0.001), waist-hip ratio (p < 0.001), body surface area (p < 0.001), and body mass index (p = 0.001). According to multivariate analysis of these variables, only percentage of weight loss and skeletal muscle remained statistically significant. Endurance had no correlation with any of the variables. Higher weight loss was found in tumors of the upper tract (stomach and pancreas) in comparison with those of the lower tract (colorectal) (p = 0.005).

CONCLUSIONS

In advanced digestive cancer, sub-maximal strength correlated inversely with weight loss and directly with skeletal muscle such as in lung and head and neck cancers. On the other hand, endurance had no correlation with any of the variables considered.

An intervention improving prescribing practices and monitoring drugs availability in a district

To improve the quality of health care in Nepal, supervision/ monitoring involving periodic visits by the district supervisor to health facilities (top-down approach) is in practice. It is not objectively implemented because of time and financial constraints and terrain of the country. To assess the effectiveness of a pre-tested strategy i.e. peer-group discussion with self-assessment piloted through the district health system in improving quality of care. A pre-post pilot study was conducted in 41 PHC facilities of Chitwan district of Central Nepal. The intervention included small-group training to prescribers followed by peer-group discussion with self-assessment data. It involved visit of in-charges from health facilities to district level regular meeting with self-assessment data on the treatment of four targeted health problems and also the availability of drugs of their health facilities as well as from health facilities which were under their supervision (bottom-up approach). In under-five children, there was a significant improvement in use of antimicrobials in diarrhoea, paracetamol alone and antibiotics in no pneumonia, and co-trimoxazole or amoxycillin alone or with paracetamol in pneumonia. The use of benzyl benzoate or gamma benzene hexachloride alone and antibiotics in scabies were also significantly improved. The peer-group discussion, a bottom-up approach of supervision/monitoring implemented through district health system improves the prescribing practices and availability of drugs in the district.

INAA methodology using low power reactor for the characterization of IAEA-433; Coastal marine sediment as a potential reference material

As a major requirement for adopting a well-defined quality system for our instrumental neutron activation analysis laboratory regular participation in the IAEA intercomparison exercises is carried out in routine. IAEA marine sediment (IAEA-433) as a proposed reference material has been studied and thirty elements have been determined employing appropriate irradiation, cooling and counting protocols using instrumental neutron activation analysis (INAA) technique. Employing the same protocols on IAEA SL-1 and IAEA 405 certified reference materials the method has been validated and our values show good agreement with the certified values predicting good accuracy. Miniature neutron source research reactor has been utilized for this work. The results for the IAEA-433 present good precision of less than 5% for Mn, Hf, Sm, Th, Al and Fe whereas for Rb, Tb, V, Se, Ga, Sn and Zn results are with comparatively poor precision ranging 10%–13%.

Measurement of natural radioactivity and dose rate assessment of terrestrial gamma radiation in the soil of southern Punjab, Pakistan

Activity concentrations of (226)Ra, (232)Th, (40)K and (137)Cs in soil samples collected from the most populous area of southern Punjab of Pakistan have been measured by gamma-ray spectrometry. The measured activity concentrations for these radionuclides are compared with the reported data from different other countries and it is found that measured activity concentrations are comparable with the worldwide measured average values reported by the UNSCEAR. Subsequently assessed radiological effects show that the mean radium equivalent activity (Ra(eq)) is 96.7 +/- 15.2 Bq kg(-1) and air absorbed dose rate (D) is 46.1 +/- 7.3 nGy h(-1). The values of internal and external radiation hazard indices are found to be less than unity. The annual effective radiation dose is calculated to be 0.28 +/- 0.05 mSv, which is well below the limit of 1.0 mSv y(-1) recommended by the International Commission on Radiological Protection, for the general public.