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Background and aims Oral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients. Methods A cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis). Results The prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL. Conclusion The inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients.

According to the United States Environmental Protection Agency (USEPA), a number of drug entities and pharmaceutical formulations, generated in health care facilities, meet the definition of hazardous waste, including epinephrine, warfarin, nicotine, and seven chemotherapeutic agents. This study has been carried out to assess the hazardous pharmaceutical waste generation in one large multi-specialty hospital in Alexandria for the ultimate objective of recommending an environmentally sound management plan for this waste. Alexandria University Main Hospital was selected for the study. A checklist containing the names of the drugs that are considered hazardous upon disposal was developed. Data concerning the generation and the management of this waste were collected using 2 questionnaire forms. The study revealed that ten hazardous pharmaceuticals are generated from the hospital departments. They are Epinephrine, m-cresol, phenol, silver sulfadiazine, multi-mineral formulations containing Cr and Se, warfarin, cyclophosphamide, chlorambucil, melphalan, and daunomycin. These drugs, as well as the other pharmaceutical waste, are managed as infectious waste: collected in yellow bags, stored in the storage area for infectious waste, and transported by the Private Company responsible for solid waste management in Alexandria Governorate to treatment by shredding and autoclaving prior to ultimate landfill. Consequently, the study recommended a hazardous pharmaceutical waste management plan taking into consideration other equally hazardous drugs such as all chemotherapeutic agents, mutagenic or teratogenic substances, endocrine disruptors, and immunosuppressant drugs. Thermal destruction of all these drugs would provide the highest level of best management practice available at this time. The ash resulting has to be tested and eventually disposed in a lined hazardous waste landfill.

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Background: Glutamine dipeptide (Gln) is one of conditionally essential amino acids that have a crucial role in cancer. Objectives: The aim of this study was to investigate the effects of early Gln supplementation in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy, but without bone marrow transplant and regardless of receiving parenteral nutrition. Methods: A randomized control trial was carried out and included 46 AML patients who received high dose chemotherapy. Their ages ranged between 17-65 years. AML patients were randomly allocated as intervention group (Gln group; n=23) and control group (n=23). Gln group received intravenous supplementation with Gln (40 gm) from day 1 to day 5 of chemotherapy, while the patients in the control group received 40 gm per day of a standard amino acid mixture. Clinical end points included the body weight, body mass index, length of hospital stay, days of neutropenia, superoxide anion generation and length of neutropenic fever and serum albumin difference. White blood cells and absolute neutrophil count were done every second day till ANC reached >500µl then superoxide anion generation was measured. Results: Weight loss, length of hospital stay, the mean days of neutropenia and neutropenic fever were significantly lower in the Gln group, whereas the mean superoxide anion generation was found higher comparing to the control group (50 ng/L vs 43ng/L respectively). Complications other than febrile neutropenia were significantly less common in Gln group. Gln supplementation has resulted in significant improvement in serum total protein and serum albumin. Conclusion: This trial suggested that early Gln supplementation regardless receiving parenteral nutrition enhances neutrophil function, maintains nutritional status and decreases hospital stay.