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Malnutrition is a universal problem in cancer patients renowned as an important factor for increased morbidity, decreased quality of life and high mortality. Early diagnosis of malnutrition risk through nutrition screening followed by comprehensive and timely interventions reduces mortality associated with malnutrition. The Scored Patient-Generated Subjective Global Assessment (PGSGA) method has been proved efficient in identifying cancer patients with nutrition challenges and guiding appropriate interventions. However this tool has not been adopted in management of cancer patients in Kenya. The aim of the study was to assess and describe nutrition status of cancer outpatients receiving treatment at Kenyatta National Hospital Hospital (KNH) and Texas Cancer Centre (TCC).
The study adopted a hospital based descriptive cross sectional study. Cancer outpatients with confirmed stage 1-4 cancers, physically stable, aged 18 years and above and receiving cancer treatment were recruited and assessed using Scored PGSGA tool. Proportions, measures of central tendency and pearsons’ chi-square test were used in statistical analysis.
Among the 471 participants assessed, 71.8% were female and 28.2% male. Most participants had stage 2, 3 and 4 cancers at 27.2%, 27.2% and 24.3% respectively. Highest proportion of participants had breast (29.7%) and female genital cancers (22.9%). Sixty nine percent of participants were well nourished (SGA-A), 19.7% moderately malnourished (SGA-B) and 11.3% severely malnourished (SGA-C) and this difference was statistically significant. The mean PGSGA score was 6.76 (SD 5.17). Based on the score, 33.8% of participants required critical nutrition care, 34.8% symptoms management, 14.2% constant nutrition education and pharmacological intervention while 17.2% required routine assessments and reassurance. More (m;54.7%, f; 45.3%) males than females were severely malnourished(SGA-C) and this was statistically significant (P < 0.001).Prevalence of severe malnutrition was highest among participants with digestive organ cancers (49.1%) followed by those with lip cancer (17%) and the least prevalence reported in those with Karposi Sarcoma (0%). Most of stage 4 participants were moderately (37.5%) and severely (29.4%) malnourished. Conclusions The Scored Patient-Generated Subjective Global Assessment is able to identify cancer patients both at risk of malnutrition and those severely malnourished. It also provides a guideline on the appropriate nutrition intervention hence an important tool in nutrition management of cancer patients.
Cancer, Outpatients, Malnutrition, Subjective global assessment Kenya
Nutritional status of cancer outpatients using scored patient generated subjective global assessment in two cancer treatment centers, Nairobi, Kenya
Yvonne Opanga, Lydia Kaduka, Zipporah Bukania, Richard Mutisya, Ann Korir, Veronica Thuita, Moses Mwangi, Erastus Muniu, Charles Mbakaya
We identified 44844 high-quality SNPs by sequencing 92 diverse chickpea accessions belonging to a seed and pod trait-specific association panel using reference genome- and de novo-based GBS (genotyping-by-sequencing) assays. A GWAS (genome-wide association study) in an association panel of 211, including the 92 sequenced accessions, identified 22 major genomic loci showing significant association (explaining 23-47% phenotypic variation) with pod and seed number/plant and 100-seed weight. Eighteen trait-regulatory major genomic loci underlying 13 robust QTLs were validated and mapped on an intra-specific genetic linkage map by QTL mapping. A combinatorial approach of GWAS, QTL mapping and gene haplotype-specific LD mapping and transcript profiling uncovered one superior haplotype and favourable natural allelic variants in the upstream regulatory region of a CesA-type cellulose synthase (Ca_Kabuli_CesA3) gene regulating high pod and seed number/plant (explaining 47% phenotypic variation) in chickpea. The up-regulation of this superior gene haplotype correlated with increased transcript expression of Ca_Kabuli_CesA3 gene in the pollen and pod of high pod/seed number accession, resulting in higher cellulose accumulation for normal pollen and pollen tube growth. A rapid combinatorial genome-wide SNP genotyping-based approach has potential to dissect complex quantitative agronomic traits and delineate trait-regulatory genomic loci (candidate genes) for genetic enhancement in crop plants, including chickpea.
A genome-wide SNP scan accelerates trait-regulatory genomic loci identification in chickpea
Alice Kujur, Deepak Bajaj, Hari D. Upadhyaya, Shouvik Das, Rajeev Ranjan, Tanima Shree, Maneesha S. Saxena, Saurabh Badoni, Vinod Kumar, Shailesh Tripathi, C.L.L. Gowda, Shivali Sharma, Sube Singh, Akhilesh K. Tyagi, Swarup K. Parida
The SNP-based high-resolution QTL mapping mapped eight major genomic regions harbouring robust QTLs governing seed-Fe and Zn concentrations (39.4% combined phenotypic variation explained/PVE) on six chromosomes of an intra-specific high-density genetic linkage map (1.56 cM map-density). 24620 SNPs discovered from genome-wide GBS (genotyping-by-sequencing) and 13 known cloned Fe and Zn contents-related chickpea gene-orthologs were genotyped in a structured population of 92 sequenced desi and kabuli accessions. The large-scale 16591 SNP genotyping- and phenotyping-based GWAS (genome-wide association study) identified 16 genomic loci/genes associated (29% combined PVE) with seed-Fe and Zn concentrations. Of these, 11 trait-associated SNPs in the genes linked tightly with eight QTLs were validated by QTL mapping. The seed-specific expression, including pronounced differential-regulation of 16 trait-associated genes particularly in accessions/mapping individuals with contrasting level of seed-Fe and Zn contents was apparent. Collectively, the aforementioned rapid integrated genomic strategy led to delineate novel functional non-synonymous and regulatory SNP allelic-variants from 16 known/candidate genes, including three strong trait-associated genes (encoding late embryogenesis abundant and yellow stripe-like 1 protein, and vacuolar protein sorting-associated protein) and eight major QTLs regulating seed-Fe and Zn concentrations in chickpea. These essential inputs thus have potential to be deployed in marker-assisted genetic enhancement for developing nutritionally-rich iron/zinc-biofortified chickpea cultivars.
Genetic dissection of seed-iron and zinc concentrations in chickpea
Hari D. Upadhyaya, Deepak Bajaj, Shouvik Das, Vinod Kumar, C. L. L. Gowda, Shivali Sharma, Akhilesh K. Tyagi, Swarup K. Parida