PRIMARY MALIGNANT MELANOMA UTERINE CERVIX

A 40-year-old premenopausal female presented with foul-smelling per vaginal discharge for 3 months. Diagnostic work revealed a locally advanced primary malignant melanoma of uterine cervix. The patient declined pelvic surgery and was treated with Dacarbazine. Malignant melanoma is a rare tumour of skin and has been ranked in the top ve cancers of Australia and Sweden. It is a tumour of melanocytes which forms melanin pigment in the skin. In men, the most common site is trunk while in females common site is limbs. However, melanoma can arise from mucosal surfaces where the melanocytes are present. Most common mucosal sites are head and neck followed by female genital tract. Key words: Cervix, dacarbazine, malignant melanoma

Complete Study of an Original Power-Exponential Transformation Approach for Generalizing Probability Distributions

In this paper, we propose a flexible and general family of distributions based on an original power-exponential transformation approach. We call it the modified generalized-G (MGG) family. The elegance and significance of this family lie in the ability to modify the standard distributions by changing their functional forms without adding new parameters, by compounding two distributions, or by adding one or two shape parameters. The aim of this modification is to provide flexible shapes for the corresponding probability functions. In particular, the distributions of the MGG family can possess increasing, constant, decreasing, “unimodal”, or “bathtub-shaped“ hazard rate functions, which are ideal for fitting several real data sets encountered in applied fields. Some members of the MGG family are proposed for special distributions. Following that, the uniform distribution is chosen as a baseline distribution to yield the modified uniform (MU) distribution with the goal of efficiently modeling measures with bounded values. Some useful key properties of the MU distribution are determined. The estimation of the unknown parameters of the MU model is discussed using seven methods, and then, a simulation study is carried out to explore the performance of the estimates. The flexibility of this model is illustrated by the analysis of two real-life data sets. When compared to fair and well-known competitor models in contemporary literature, better-fitting results are obtained for the new model

Clinical and Dosimetric Implications of Air Gaps between Bolus and Skin Surface during Radiation Therapy

Purpose: The main objective of the study was to evaluate the effect of air gaps of 0 - 5.0 cm between bolus and skin for 1.0 cm Superflab bolus on surface dose (DSurf) and depth of maximum dose (dmax) in solid water and Rando® phantoms. Methods: In this work, the effects of bolus to surface distance on DSurf and variation in dmax were analyzed in a solid water phantom and in an anthropomorphic Rando® phantom for different field sizes, using Gafchromic® EBT films and farmer chamber. Results: For field sizes of 5 × 5 cm2 the DSurf is significantly affected by increasing air gaps greater than 5 mm. For field sizes larger than 10 × 10 cm2, DSurf is nearly the same for air gaps of 0 - 5.0 cm. For small fields and 6 MV photon beam, dmax increases with increasing air gap, while for 10 MV beam and smaller field sizes (i.e. 5 × 5 and 10 × 10 cm2) the dmax first decreases and then increases with the air gaps. For both 3DCRT and IMRT plans on Rando®, DSurf reduction is more prominent with increasing air gaps. Conclusion: For field sizes larger than 10 × 10 cm2 DSurf is largely unaffected by air gaps. However, smaller air gap results in shallower dmax for both 6 MV and 10 MV photon beams at all fields sizes. Special consideration should be taken to reduce air gaps between bolus and skin for field sizes smaller than 10 × 10 cm2 or when surface contour variations are greater or when the bolus covers small area and at the border of the field

Design and study of a small implantable antenna design for blood glucose monitoring

In this paper, a miniaturized implantable antenna with the dimensions of 8×8×1 mm3 has been studied for continuous monitoring of Blood Glucose Levels (BGL). The antenna performance is analyzed numerically for both the free space and implanted operation. The results show that the works excellently in both the scenarios. The antenna has the lowest resonant frequency of 3.58 GHz in free space with a gain 1.18 GHz while it operates at 2.58 GHz with a gain of 4.18 dBi. Good performance, small size and resilience to the human body effects make the antenna to have a good potential use in future implantable glucose monitoring devices

Epidemiology of Stroke in the MENA Region: A Systematic Review.

Introduction: Stroke is a major burden on the health system due to high fatality and major disability in survivors. Whilst Stroke incidence has declined in the developed world, it continues to increase in developing nations, including the MENA (Middle East and North Africa) region. This may reflect different risk factors and strategies to treat and manage patients prior to and after Stroke. Methods: We have conducted a systematic review of the prevalence, incidence and mortality of Stroke in the 23 countries of MENA region following the PRISMA guidelines. Results: 8,874 published papers were retrieved through both PubMed and Embase. Of those, 38 studies were found to be eligible for inclusion in this review. Only thirteen countries in the MENA region had data points for the critical stroke parameters. Of these qualified studies, 14 were prospective, population-based studies. In the age-adjusted studies, incidence ranged widely between 16/100,000 in a prospective population-based in Iran to 162/100,000 in Libya. Age-adjusted prevalence was available only from Tunisia at 184/100,000. Mortality for all strokes from the eight countries reporting this measure found the 30 day-case fatality ranged from 9.3% in Qatar to 30% in Pakistan. Most stroke studies in the MENA region were small sized, hospital-based, lacked confidence intervals and did not provide prevalence and mortality figures. Conclusion: National policymakers, public health and medical care stakeholders need more reliable epidemiologic studies on Stroke from the MENA region to plan more effective preventive and therapeutic strategies

Soil application of Bacillus thuringiensis Berliner isolates against root-knot nematode (Meloidogyne javanica (Treub) Chitwood) in okra (Abelmoschus esculentus (L.) Moench)

Bacillus thuringiensis (B.t) is well known for its biocontrol potential against a variety of insects. Nematicidal potential of ten B.t isolates was tested against root-knot nematodes (Meloidogyne javanica (Treub) Chitwood) in vitro, under greenhouse as well as in field conditions. Eggs and second stage juveniles (J2) were exposed to 5 and 25% concentrations of bacterial cell-free aqueous extracts up to 96 h. B.t isolates showed lesser degrees of nematicidal activity at 5% concentration. However, some B.t isolates (B.t-14, B.t-16 and B.t-64) greatly reduced egg hatching and increased J2. All B.t isolates revealed suppressed egg hatching and increased mortality of J2 at 25% concentration. Soil applications with most of the B.t isolates under greenhouse and field conditions significantly improved height and fresh weights of root-knot nematode parasitized okra (Abelmoschus esculentus (L.) Moench). Some isolates, including B.t-64 reduced the number of galls and egg masses. B.t-64 reduced gall formation up to 70% under greenhouse conditions. However, 29% of decrease was observed in field conditions. Similarly, B.t-64 treated plants showed a 56% decreased in eggs/egg mass in a field experiment. Population of root-knot nematodes in the rhizosphere was decreased up to 61% in the field experiment as compared to control

Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: Casirivimab and imdevimab are non-competing monoclonal antibodies that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike glycoprotein, blocking viral entry into host cells. We aimed to evaluate the efficacy and safety of casirivimab and imdevimab administered in combination in patients admitted to hospital with COVID-19. Methods: RECOVERY is a randomised, controlled, open-label platform trial comparing several possible treatments with usual care in patients admitted to hospital with COVID-19. 127 UK hospitals took part in the evaluation of casirivimab and imdevimab. Eligible participants were any patients aged at least 12 years admitted to hospital with clinically suspected or laboratory-confirmed SARS-CoV-2 infection. Participants were randomly assigned (1:1) to either usual standard of care alone or usual care plus casirivimab 4 g and imdevimab 4 g administered together in a single intravenous infusion. Investigators and data assessors were masked to analyses of the outcome data during the trial. The primary outcome was 28-day all-cause mortality assessed by intention to treat, first only in patients without detectable antibodies to SARS-CoV-2 infection at randomisation (ie, those who were seronegative) and then in the overall population. Safety was assessed in all participants who received casirivimab and imdevimab. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between Sept 18, 2020, and May 22, 2021, 9785 patients enrolled in RECOVERY were eligible for casirivimab and imdevimab, of which 4839 were randomly assigned to casirivimab and imdevimab plus usual care and 4946 to usual care alone. 3153 (32%) of 9785 patients were seronegative, 5272 (54%) were seropositive, and 1360 (14%) had unknown baseline antibody status. 812 (8%) patients were known to have received at least one dose of a SARS-CoV-2 vaccine. In the primary efficacy population of seronegative patients, 396 (24%) of 1633 patients allocated to casirivimab and imdevimab versus 452 (30%) of 1520 patients allocated to usual care died within 28 days (rate ratio [RR] 0·79, 95% CI 0·69–0·91; p=0·0009). In an analysis of all randomly assigned patients (regardless of baseline antibody status), 943 (19%) of 4839 patients allocated to casirivimab and imdevimab versus 1029 (21%) of 4946 patients allocated to usual care died within 28 days (RR 0·94, 95% CI 0·86–1·02; p=0·14). The proportional effect of casirivimab and imdevimab on mortality differed significantly between seropositive and seronegative patients (p value for heterogeneity=0·002). There were no deaths attributed to the treatment, or meaningful between-group differences in the pre-specified safety outcomes of cause-specific mortality, cardiac arrhythmia, thrombosis, or major bleeding events. Serious adverse reactions reported in seven (<1%) participants were believed by the local investigator to be related to treatment with casirivimab and imdevimab. Interpretation: In patients admitted to hospital with COVID-19, the monoclonal antibody combination of casirivimab and imdevimab reduced 28-day mortality in patients who were seronegative (and therefore had not mounted their own humoral immune response) at baseline but not in those who were seropositive at baseline. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

BACKGROUND: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. METHODS: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). FINDINGS: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). INTERPRETATION: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids