Patient Reported Outcomes Following Palliative Whole Brain Radiation Therapy in Patients with Brain Metastasis

PURPOSE/OBJECTIVE(S)

Brain metastases (BM) are a common occurrence in patients with advanced cancers, and extremely challenging to treat, resulting in short survival periods. Consequently, whole brain radiation therapy (WBRT) remains the standard palliative intervention for patients with BM. The present study set to evaluate the efficacy of WBRT by assessing the quality of life (QoL) and survival outcomes in WBRT-treated patients with BM. It was hypothesized that the WBRT would enhance the QoL through alleviation of symptoms and functionality, and prolong patient survival.

MATERIALS/METHODS

This was a prospective, longitudinal, hospital-based single-center study. Consecutive sampling methodology was used to recruit 52 patients with BM undergoing WBRT. Patients were followed up on days 7, 30, 90 and 180 after WBRT. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative care (EORTC QLQ-C15-PAL) was employed to report patient responses in a Likert scale. A descriptive analysis and multi-trait scaling correlation was computed using IBM SPSS Statistics 29.0, 95% confidence interval. The overall survival analysis (Kaplan-Meier) was also performed.

RESULTS

The study cohort was predominantly females (82.7%), and accordingly, 65.4% of the respondents had a breast primary tumor. A Shapiro-Wilk test of normality revealed that the data was not normally distributed (sig. < 0.05), however, statistic values (W) closer to 1 suggested a good fit. A goodness-of-fit test ascertained the assumption, yielding non-significant Chi square Pearson (p = 0.325) and Deviance (p = 1.000) residuals. There was a significant correlation (p < 0.001) between physical functioning and emotional functioning. Median overall survival was 180 days (∼6 months). A total of 20 patients (38%) that survived up to 180 days reported alleviated symptoms and better functioning. A significant improvement in physical functioning (p < 0.001) and emotional functioning (p = 0.031) was reported at 180 days post WBRT, compared to baseline. Similarly, a significant improvement in visual disorders (p = 0.002), motor dysfunction (p = 0.031), and communication deficit (p = 0.001) was also reported. A significant alleviation of pain was reported at day 90 (p = 0.042) by 53% of the patients that survived.

CONCLUSION

WBRT is an effective palliative intervention in patients with BM, resulting in improved QoL and prolonged survival. More than 50% of patients that survived 3 months reported a significant alleviation of pain, and 38% of patients that survived for 6 months reported a significantly improved functioning. This demonstrated the effectiveness of WBRT in palliative care and will add to the body of data on the efficacy of radiotherapy.

Reasons and pattern of tooth extraction among patients presenting at a Nigerian semi-rural specialist hospital

BACKGROUND

Oral health is greatly influenced by health teeth.

OBJECTIVE

The study is to determine the reasons and pattern of tooth extraction in patients seeking care at the oral surgery/Dental clinic in Rasheed Shekoni Specialist Hospital, Dutse, Jigawa between January 2010 and December 2011.

METHODS

A retrospective review of records of dental extraction patients. Patients' records were analyzed for demographics, reason(s) for tooth extraction and tooth/teeth extracted.

RESULTS

During the 2 years study period, 349 patients (M:F = 1.3:1) aged 2-65 years (mean = 29.7 years +/- 11.5 SD) had extraction of 377 teeth. Dental caries and its sequelae (91.2%) was the most frequent reason for tooth extraction across all age groups, followed distantly by periodontal disease (3.2%) and recurrent pericoronitis (3.0%). The highest proportion of extraction occurred between age 21 to 30 years of age. Mandibular first molars were the most commonly extracted tooth due to dental caries, followed by maxillary first and mandibular second molars. Mandibular molars were by far the more frequently extracted than maxillary molars.

CONCLUSION

Dental caries and its sequelae was the main reason for removal of teeth in this section of Nigerian population. Therefore, there is urgent need to focus on the prevention and treatment of dental caries and its sequelae in order to maintain functional and healthy teeth throughout life.

Aflatoxin-mediated Sperm and Blood Cell Abnormalities in Mice Fed with Contaminated Corn

The effect of aflatoxin-contaminated corn on albino mice was investigated using the sperm morphology assay. Blood parameter levels including; total white blood cells (WBC), total red blood cells (RBC), packed cell volume (PCV), serum bilirubin (SB) and fasting blood sugar (FBS) were also determined in the tested mice. Test mice were exposed to aflatoxin-contaminated corn (contamination level of 100 ppb) for 1~4 weeks while aflatoxin-free corn and cyclophosphamide were used as negative and positive controls, respectively. Sperm cells showed varieties of morphological abnormality when assessed after 5 weeks. The percentage frequencies of the negative and positive controls were 18.8% and 48.87%, respectively, while the percentage abnormalities for the 1, 2, 3 and 4 weeks exposures were 41.38%, 48.17%, 57.13% and 61.67%, respectively. PCV, WBC, total bilirubin and glucose level values of mice in all concentrations were higher and statistically significant as compared to the negative control values using Dunnett's test. Therefore, abnormal sperm cell induction is concentration-dependent such that continuous consumption of aflatoxin-contaminated corn is capable of negatively affecting spermatogenesis by inducing or increasing the frequency of morphologically abnormal sperm cells produced.

Disputed paternity: experience in Ile-Ife, Nigeria

Results of paternity tests carried out in our hospital between September, 1984 and December, 1993 were analysed. There were 44 cases consisting of 37 (84.1%) groups of four each: the child, the mother and the two alleged fathers, and 7 (15.9%) groups of three, including the disputed child, the mother and the alleged father. Most of the disputed victims were children under age 10 years (97.7%), the oldest 'child' in dispute was 35 years. The total cumulative paternal exclusion rate with our standard techniques was only 27.5% consisting of 15.9% for ABO blood group system, 2.3% for Rhesus-D system and 9.3% for haemoglobin electrophoresis analysis. This is far below the exclusion rate of up to 97% and 99.9% obtained with the more reliable tests such as HLA and DNA analyses, respectively. There is a need to introduce a more reliable screening package for paternity testing in our specialised hospitals in order to ease the associated medicolegal problems since all the cases but one seen were referred from law courts.