The Impact of Malnutrition on the Quality of Life of Colorectal Cancer Patients in a Tertiary Hospital.

Malnutrition among colorectal cancer patients can impair quality of life and decrease survival. This study evaluated the nutritional status of colorectal cancer patients and its association with quality of life among Filipino colorectal cancer patients seen in a tertiary hospital. A cross-sectional study was conducted among colorectal cancer patients seen at the Philippine General Hospital between December 1, 2019 and February 28, 2020. Nutritional status was evaluated using the Subjective Global Assessment, while quality of life was assessed using the EORTC QLQ-C30. Descriptive statistics, ANOVA and logistic regression were employed for analysis. Among 292 patients, malnutrition was noted in 76.4%. Stage III cancer had a higher odds for malnutrition (OR (odds ratio) = 6.22, 95% confidence interval (CI): 1.59, 24.42). Patients who received or were currently receiving chemotherapy were less likely to develop malnutrition (OR = 0.35, 95% CI: 0.18-0.69). Global health status and all functional subscale scores for the severely malnourished group were lower while the scores for symptom scales increased with the degree of malnutrition. There was a high prevalence of malnutrition among colorectal cancer patients and this was associated with poor quality of life. Future directions emphasizing early nutritional screening and assessment are recommended.

Follicular Dendritic Cell Sarcoma of the Tonsil: A Multimodality Approach.

Follicular dendritic cell sarcoma (FDCS) accounts for < 0.4% of soft tissue sarcomas. Only 35 cases of tonsillar FDCS have been reported, and majority had localized presentation. We present a case of FDCS of the tonsil, wherein a well-coordinated trimodality approach provided good disease control in advanced disease. A 53-year-old man presented with a painless and enlarging neck mass of 11-month duration, with no other symptoms. Close examination revealed a 10 × 5 cm mass at the left carotid triangle, and a 3.2 × 2.2 cm mass at the left tonsillar fossa. Imaging revealed the tumor to be unresectable due to its attachment to the great vessels. There were no distant metastases. Biopsy and immunohistochemistry were initially deemed consistent with an undifferentiated sarcoma. Palliative chemotherapy was given using single agent doxorubicin and subsequent dacarbazine, resulting in partial response and stable disease, respectively. Pathological re-evaluation was pursued because of the uncharacteristic slow progression of the tumor, revealing diffuse positivity for CD21 and negative for CD1A and CD34, consistent with FDCS. The patient underwent three cycles of gemcitabine plus docetaxel resulting in 50% regression. This allowed dissection of level IB-V lymph nodes and subsequent radiotherapy for the neck and tonsillar mass, with weekly gemcitabine as a radiosensitizer. Evaluation 8 months post-treatment showed no signs of disease progression. Treatment-related complications included radiation dermatitis and swallowing dysfunction, which both resolved on follow-up. This case highlights the multidisciplinary management of a rare type of sarcoma in an uncommon anatomic location. Precise pathologic diagnosis is important in soft tissue sarcoma because of its therapeutic implications. For FDCS, effective response may still be achieved in the third-line setting.

Hepatocolic fistula: a rare presentation of pyogenic liver abscess.

A 58-year-old man was admitted due to a 4-month history of colicky right upper quadrant pain, intermittent fever, anorexia and weight loss. A contrast-enhanced CT scan of the abdomen showed an encapsulated, peripherally enhancing focus occupying the right liver lobe exhibiting capsular rupture and extension to the walls of the hepatic flexure. He immediately underwent emergency ultrasound-guided percutaneous catheter drainage and cultures of the purulent fluid later revealed Escherichia coli A colonoscopy was then performed which showed a pinpoint opening with draining pus at the hepatic flexure. A fistulogram confirmed a fistulous tract arising from the inferior aspect of the abscess cavity, draining into the posterosuperior aspect of the hepatic flexure. He was started on intravenous antibiotics and after 1 week of decreasing output, a repeat ultrasound showed very minimal residual fluid. The percutaneous catheter drain was then removed after 2 weeks and the patient was discharged improved.

The role of prophylactic renin-angiotensin system inhibitors for the prevention of anthracycline-induced cardiotoxicity among adult cancer patients: A meta-analysis

INTRODUCTION: Anthracycline is a cornerstone in the treatment of various cancers. One major limitation to its use is cardiotoxicity. Renin angiotensin system (RAS) inhibitors have been shown to attenuate myocardial injury, initial data is promising in its use as prophylaxis for anthracyclineinduced cardiotoxicity. The aim of the study is to determine effectiveness of prophylactic RAS inhibitors in preventing anthracycline-induced cardiotoxicity and adverse cardiac events among adult cancer patients METHODS: Systematic search of databases PUBMED, MEDLINE, EMBASE, and CENTRAL was done. Selection criteria were: 1) randomized controlled trials (RCT) 2) adult cancer patients with normal ejection fraction and without heart failure symptoms 3) RAS inhibitors as prophylaxis versus placebo 4) development of cardiac events, all-cause mortality and left ventricular ejection fraction (LVEF) reduction as outcomes. Two reviewers independently assessed the trials. Disagreements were resolved with a third reviewer. Test for effect of intervention, heterogeneity, trial quality and risk of bias were assessed using the Cochrane Review Manager Software version 5.3. RESULTS: Five RCTs involving 530 adult patients, with average age of 50± two years old, and average follow-up from six months to three years were included. Combined clinical outcomes of heart failure, cardiac events and all-cause mortality showed an RR of 0.27[95%CI 0.18, 0.40],p CONCLUSION: Renin angiotensin system (RAS) inhibitors may be used as prophylaxis for cardiotoxicity. As prophylaxis, it reduced the clinical outcome of cardiac events, heart failure, and all-cause mortality among cancer patients needing anthracycline. Combined RAS inhibitor and betablocker limits LVEF reduction.