الفهرس 
I IntroductionOnly 14 pages are availabe for public view
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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.
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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).
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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.
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• 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.
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• 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:
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• 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.
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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.