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Abstract The major function of the immune system is to protect the body against infectious diseases. The immune system can be divided into innate and adaptive immunity. The immune system operates at the systemic as well as at the local level, which includes the mucosal tissue such as in the upper airways and the gut. A fundamental characteristic of the immune system is that it involves multiple, functionally differing cell types, which permit a large variety of defense mechanisms (Albers et al., 2010). Nutrition is known to affect the immune system and thereby modulates resistance to infection. At the single nutrient level, it has been show that all immune functions rely on an adequate nutrient supply in order to function properly. Human trials have provided evidence that supplementation with single nutrients, as well as qualitative changes in certain macronutrients, affect specific immune functions even in wellnourished individuals (Albers et al., 2005). A major focus of current research is the role of specific food components or foods (Omega 3 fatty acids) in enhancing immune system responsiveness to challenge with the aim of improving health and reducing disease risk. Target groups are the certain vulnerable groups with particular sensitivity towards infectious diseases (mastectomized patients). The aim of the current study is to determine the effect of preoperative nutritional supplementation of omega-3 fatty acid on the postoperative immune response and surgical outcomes of patients undergoing mastectomy. 120 Setting of the study The current study was conducted at surgical department of Menoufiya University Hospital and Sheibin El Kom Teaching Hospital, Menoufiya governorate, Egypt. The study was extended from the period of the first of March 2011 to the end of April 2012. Sample of the study The study was conducted on sample of 60 available female adult patients diagnosed as having breast cancer eligible for the study criteria. The following research hypotheses were formulated in an attempt to fulfill the aim of the study: - 1. Subjects who receive nutritional supplementation with omega 3 fatty acid (study group I) will show faster wound healing than subjects who do not receive it (control group II). 2. Wound infection will be lesser among subjects receiving nutritional supplementation with omega 3 fatty acid (study group I) than subjects who do not receive it (control group II). 3. Subjects who receive nutritional supplementation with omega 3 fatty acid (study group I) will show improvement in the postoperative immune status as evidence by increase antibody production, activation of T cells or both, and modulate lymphocyte proliferation than subjects who do not receive it (control group II). 4. Length of hospital stay will be lesser among subjects receiving nutritional supplementation with omega 3 fatty acid (study group I) than subjects who do not receive it (control group II). 121 Tools of the study Four tools were used for data collection based on extensive review of literature. These tools were:- Tool 1: Knowledge Assessment Sheet: Appendix II Tool 2: Nutritional Assessment Sheet: Appendix III Tool 3: Immune Response Assessment Sheet: Appendix IV Tool 4: Wound Assessment Sheet: Appendix V Tool 1: Knowledge Assessment Sheet: Appendix II It was developed by the researcher after reviewing a related literature. To assess breast cancer patient’s knowledge regarding nutrition and its relation to wound healing and immune system from the patient’s perspectives, in order to assess the needs of health education. it was in Arabic and comprised of three parts as the following:- Part one: Bio-sociodemographic Data: It include data related to patient’s sociodemographic data as name, age, sex, level of education, occupation, marital status, as well as place of residence. Part two: Medical History: It recorded data related to patient’s past, present medical history, surgery, and family medical history, and also it recorded data related to patient’s exposures to risk factors of breast cancer, such as early menarch, parity, usage of breast feeding, benign breast lesions before, age at the first pregnancy, menstruation cessation, usage of hormonal replacement therapy, contraceptive pills, other environmental exposure to radiation, smoking, insectisieds, , and life style risks such as sports, stresses, and style of nutrition. 122 • Part three : Patient’s Knowledge about nutrition: It include questions related to patient’s knowledge (from the patient’s perspectives) regarding to the nutrition and its relation to wound healing and immune system in order to assess the needs of health education. Tool 2: Nutritional Assessment Sheet: (Appendix III) It was developed and used by the researcher based on the review of the related literature (Beare and Myers, 1994). It used to assess nutritional status of the patients in order to exclude patients with malnutrition from the study as malnutrition may have an impact on immune function. It was comprised of five parts as the following: • Part one: Daily dietary intake chart: The twenty-four hours recall method it used by the researcher to assess patient’s dietary intake for one week before surgery. It was used to record all types and amounts of food ingested by the patient in both study and control groups regardless its source weather from the hospital or home. • Part two: Anthropometric Measurements: It included current body weight in Kg, Body Mass Index (BMI), Triceps Skin Fold (TSF), and Mid - Upper Arm Muscle Circumference. • Part three: Biochemical Measurements: It included the following laboratory tests: complete blood count (CBC), blood urea, serum creatinine, serum albumin, and Albumin/Glubin ratio. Then the researcher compares patient’s results with the normal range values to identify malnourished patients order to be excluded from the study sample. 123 • Part four: Clinical and Physical Measurements: Physical examination was performed by inspection of specific body parts for detection of clinical signs and symptoms of nutritional deficiency in the skin, lips, hair, gums, and nails (Rosdahle, and Kowalski, 2003). • Part five: Screening Summary: It was developed by (Ferguson, 1999; Age Concern, 2006) it was used to identify patients with malnutrition. The patient considered malnourished when she have one or more of the following: Unintentional weight loss of ≥ 10% of usual body weight. Body mass index < 18.5. Serum albumin level < 3.5 g/dl. Mid arm circumference < 27.7 Cm. Tool 3 : Immune Response Assessment Sheet: (Appendix IV) It was developed and used by the researcher to assess the immune response for patients undergoing mastectomy. It was comprised of the quantitative measurements to evaluate the immune system as following: 4. Total leukocyte counts. 5. Cellular immunity: • Percentage and absolute count of T lymphocytes. • CD4 Helper T cells. • CD8 Cytotoxic T cells. • CD4 / CD8 ratio (T helper/cytotoxic). 6. Immunoglobulin and immune proteins: 124 • Serum IgM level. • Serum IgG level. Tool 4 : Wound Assessment Sheet: (Appendix V) It was developed by Wilson et al., (1986), and used by the researcher to assess the wound healing, presence of wound infection and whenever a change occurs in the wound. It was included data related to the following: • Part one : 4. Assessment of wound charactristics and its relation to proportion of wound affected such as serous exudate, erythema, purulent exudate, and separation of deep tissues. 5. Additional points of assessment such as antibiotics, drainage of pus under local anasethesia, depridement of wound under general anasethesia, and isolation of bacteria. 6. Assessment of the length of patient’s hospital stay. These itemes of assessment was scored according to ASEPSIS scoring system then finally the ASEPSIS score was generated by adding the wound characteristic scores to the additional points, and the researcher evaluates the wound according to the scoring system. • Part two : Other signs of wound infection such as fever, localized pain, tenderness, or Swelling, hotness, redness, exudates amount, odour and color of the wound was observed.The main results of the present study were: 4. Oral administration of supplements enriched with omega-3 fatty acid for 5–7 days before surgery increasing humoral immunity and cellular immunity of postoperative (mastectomized) patients. 5. Oral administration of supplements enriched with omega-3 fatty acid for 5–7 days before surgery seemed to have a favorable effect on clinical outcomes of patients undergoing mastectomy. 6. There were no significance difference found in presence of wound infection, wound healing, and postoperative hospital stay between both study and control groups. Based on the findings of the present study the following recommendations are drived and suggested: D. Recommendations for patients 4. Providing specific prescribed oral supplementation enriched with Omega 3 fatty acid for patients undergoing modified radical mastectomy at least for one week before operation. 5. A booklet (manual) should be available and distributed to all patients undergoing modified radical mastectomy, with colored pictures about healthy nutrition and guidelines for improving body defense mechanism and immune system. 6. Developing health teaching program for patients and their families about balanced nutrition guide and diet rich in omega 3 fatty acid. E. Recommendations for nurses 3. Developing a structured educational program for nurses dealing with breast cancer patients regarding nutrition and omega 3 fatty acids and its benefits. 126 4. A manual should be available to all nurses dealing with breast cancer patients about pre and post mastectomy nutrition that enhance immune functions and postoperative recovery. F. Recommendation for future researches 2. Replication of the study using a larger probability sample from different geographical areas to attain more generalizable results. |