Is serum albumin an independent predictor of survival in patients with breast cancer?

BACKGROUND: The medical literature shows several examples of an inverse relationship between serum albumin levels and survival in patients with advanced cancer. METHODS: We investigated the effect of baseline serum levels on 180 consecutively treated patients who were diagnosed with breast cancer from March 1993 to December 1999 at our institution. We investigated the effect of low levels of serum albumin (<3.5 g/dL) using univariate and the multivariate Cox regression model. RESULTS: Demographically, the median age of these patients was 51 years of age, with a range of 28 to 88 years. In this series, 28 patients have died and 9 have developed a recurrence of tumor. The patient distribution by tumor stage was 53, stage 1; 47, stage 2A; 29, stage 2B; 11, stage 3; 13, stage 4A; and 21, stage 4B. In this cohort, the overall 5-year survival was 69%. The Cox regression analysis found that normal levels of albumin (>3.5 g/dL) reduced the risk of death by 72% (p = .0033). Only tumor stage had a larger impact on survival (p < .0000). Other factors achieving statistical significance were overexpression of the HER2/Neu antigen (p = .0167) and breast antigen (p = .0116). CONCLUSION: Univariate statistical analysis found that low levels of serum albumin adversely affected survival by a statistically significant level for all stages of breast cancer. We found that a baseline serum albumin level was a powerful prognostic variable, which accounted for 7.35% of the variation in patient survival time.     

Underlying causes of ill‐health in an African country

The nutritive values of some lesser known protein sources in Nigerian peasant diets were evaluated by in vitro enzyme digestion studies and by in vivo studies with rats. Snail (Vivapara quadrata), periwinkle (Littorina littorea), dried crayfish (Palamonetes varians) and locally smoked fresh water fish (Tilapia melanopleura) had a range of digestibility of 57–75 percent with pepsin/trypsin hydrolysis. The digestibility of smoked fresh water fish and crayfish in rats ranged between 91.2 percent and 89.5 percent while that of periwinkle and snail was 80.4 percent and 85.9 percent respectively. Crayfish gave the highest PER (1.8) while the others had values ranging from 0.7 to 1.5. These values were considerably lower than that of whole hen's egg (3.5). These protein samples had high biological values (70.8–81.6) which were, however, still lower than whole hen's egg (92.0) and fairly high NPU values (60.3–73.0). In general, these lesser known protein sources if consumed in adequate quantities would alleviate protein deficiency syndromes which are prevalent in a large section of our rural population.     

Branched-chain amino acids—a highly effective substrate of parenteral nutrition for critically ill children with Reye's syndrome

The use of a pure mixture of branched-chain amino acids (BCAA's) in combination with Nutramin^® C SPOFA and glucose in a group of six paediatric patients with Reye's syndrome resulted in a significant metabolic improvement. Throughout the critical stage of the disease, administration of BCAA's in a dose of 1.0 g/kg b.w. per day led to remission of metabolic acidosis and a positive potassium balance. A negative nitrogen balance persisted. The resulting changes in plasma amino acid levels indicated high BCAA's clearance rates. Introduction of BCAA's to the complex therapeutic approach apparently helps to control the Krebs cycle and promotes glucose oxidation. In our group of six patients, five children fully recovered. Inclusion of BCAA's into the arsenal of therapeutic tools applied in patients with the hepatocerebral syndrome is likely to largely improve the prognosis in this condition constituting a serious medical challenge in paediatric patients.     

Can student tutors act as examiners in an objective structured clinical examination?

Context  The dissemination of objective structured clinical examinations (OSCEs) is hampered by requirements for high levels of staffing and a significantly higher workload compared with multiple-choice examinations. Senior medical students may be able to support faculty staff to assess their peers. The aim of this study is to assess the reliability of student tutors as OSCE examiners and their acceptance by their peers.
Methods  Using a checklist and a global rating, teaching doctors (TDs) and student tutors (STs) simultaneously assessed students in basic clinical skills at 4 OSCE stations. The inter-rater agreement between TDs and STs was calculated by kappa values and paired t -tests. Students then completed a questionnaire to assess their acceptance of student peer examiners.
Results  All 214 Year 3 students at the University of Göttingen Medical School were evaluated in spring 2005. Student tutors gave slightly better average grades than TDs (differences of 0.02–0.20 on a 5-point Likert scale). Inter-rater agreement at the stations ranged from 0.41 to 0·64 for checklist assessment and global ratings; overall inter-rater agreement on the final grade was 0.66. Most students felt that assessment by STs would result in the same grades as assessment by TDs (64%) and that it would be similarly objective (69%). Nearly all students (95%) felt confident that they could evaluate their peers themselves in an OSCE.
Conclusions  On the basis of our results, STs can act as examiners in summative OSCEs to assess basic medical skills. The slightly better grades observed are of no practical concern. Students accepted assessment performed by STs.     

Assessment of whole body protein metabolism in critically ill children: can we use the [15N]glycine single oral dose method?

BACKGROUND & AIMS: Most stable-isotope methods to evaluate whole body protein metabolism in patients are invasive and difficult to use in children. In this study protein metabolism was evaluated with the non-invasive [15N]glycine single oral dose method in critically ill children and the value of the method is discussed. METHODS: [15N]glycine (100mg) was given orally to children (mean age 5.5 years; range 0.6-15.5 years) with meningococcal septic shock (MSS, n = 8), pneumonia (n = 5), and to healthy, fed and post-absorptive children (n = 10). Urine was collected during 9h, total amount of NH(3), labelled NH(3) and nitrogen were measured, and protein turnover, synthesis and breakdown were calculated using urinary NH(3) as end-product. RESULTS: Mean protein turnover in children with MSS, pneumonia and fed and post-absorptive healthy children was 0.63+/-0.13, 0.38+/-0.10, 0.28+/-0.03 and 0.28+/-0.02g N/kg/9h, respectively. Mean protein synthesis was 0.55+/-0.12, 0.29+/-0.09, 0.18+/-0.02, 0.20+/-0.02g N/kg/9h, respectively. Mean protein breakdown was 0.56+/-0.14, 0.28+/-0.12, 0.08+/-0.03, 0.28+/-0.02g N/kg/9h, respectively. Protein turnover, synthesis and breakdown were significantly increased in MSS patients compared to fed healthy children (P <0.01) and post-absorptive children (P <0.05). Protein turnover, protein synthesis, protein breakdown were significantly correlated with disease severity and body temperature (P <0.05). CONCLUSION: Results of whole body protein metabolism measured with the [15N]glycine single oral dose method in children with MSS and in healthy children were in line with expectations based on results obtained in earlier reports and with different methods.