Glioblastoma multiforme: etiology, progression, and treatment

Glioblastoma multiforme is the most common and malignant brain tumor, accounting for more than 52% of all primary brain tumors. The molecular heterogeneity of the tumor has made it difficult to treat, and even more difficult to cure. Due to the high mortality rate associated with the current treatments used, new innovative medical techniques are being explored. Prominent treatments that are currently being investigated are immune based therapies, focused on checkpoint inhibitors and biomarkers, the use of 2-deoxy-D-glucose to initiate tumor cell apoptosis, and the induction of alterations in DNA and miRNA to inhibit glioblastoma stem cell accelerated growth and tumorigenesis. Throughout the paper, various ongoing studies are summarized and discussed to compare the outcomes of different treatments. The goal of this paper is to present the different therapies and analyze which one of them is the most effective in treating and prolonging survival for patients with glioblastoma multiforme. This thesis reviewed the large collection of publications about glioblastoma multiforme and treatments for the disease. The use of immune based therapies, such as checkpoint inhibitors and biomarkers, are increasingly delivering promising results as an immunotherapy approach, but it is necessary to complete the phase III trials in order to truly know if these products are successful as anticancer agents or if further research into the matter is required. More research must be done to find the best route of treatment. In addition, the use of 2-deoxy-D-glucose has been successful in treating other types of cancer, such as breast cancer, and now studies look promising in GBM patients. This treatment is still in its initial stages of testing, so more work will need to be done to determine how efficacious this treatment is. By comparing the results of the different therapeutic agents, it was determined that genetic alterations seemed to be the most promising avenue of treatment with current information. The data showed that the greatest increase in survival time and least recurrence was achieved by MGMT promoter methylation and gene modifications of the tumor. Though these treatments have varying results in their efficacy and there are many different combinations of medications that have yet to be assessed, research in the area is greatly advancing and increasing the lives of GBM patients. By allocating resources in the best possible treatment, researchers can change the fatal prognosis of this illness

Meeting the Unique Treatment Needs of Female Gamblers: A Workbook and Webinar Effectiveness Pilot Study

While past decades have seen a dramatic increase in the number of women who gamble and develop consequent problems, treatment services are being underutilized in Ontario, especially by women. This pilot aimed to be responsive to this concern, circumventing barriers by inviting access to support through the use of two interventions. One was a mailed self-help workbook designed for women. The second utilized the workbook in a clinician facilitated group context using teleconferencing in conjunction with webinar technology. This small pragmatic pilot aimed to both get feedback on the helpfulness of the workbook and to explore the feasibility of using web and phone based group interventions. The presentation will takes us on a brief tour of current research knowledge about barriers to treatment, and highlight the distinct treatment considerations in working with women, the value of a women’s group, the increasingly utilized role and advantages of phone counselling, the modern explosion of web based services and the added value of self-help materials for gamblers. We’ll review the content and rationale of the self-help workbook, a manual drawing from best practices and research in diverse areas relevant to women’s recovery. A mixed method analysis found that the interventions were well received by women in both Canada and the USA. We’ll review both qualitative and quantitative results. This innovative and original treatment intervention holds considerable promise in expanding options for women who might not otherwise seek or be able to access treatment

The concept of dispute resolution in Islamic Law

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A study of caesarean section at full cervical dilatation

Background: Caesarean sections performed in the second stage of labour are difficult and have many implications on both mother and baby. This study was conducted to analyse fetal and maternal outcome in case of caesarean section at full cervical dilatation.Methods: This prospective study was conducted at one of tertiary care teaching institute for period of 1st August 2019 to 31st January 2020. It includes all women delivered by caesarean section at full cervical dilatation at study institute during study period. Cases were looked for parity, maternal age, gestational age, baby birth weight, indication of cesarean section and associated factors.Results: Out of total 3657 deliveries 1690 were delivered by caesarean section, out of which 65 (3.8%) caesarean sections were conducted at full cervical dilation. The most common indication of caesarean section was deep transverse arrest in 66.15% of cases. The maximum number of cases (69.23%) were seen between the age group of 20 to 25 years. Majority of second stage cesarean section (70.77%) were performed in primi gravida. 80% of caesarean sections at full cervical dilatation were performed after 37 weeks of gestation. 15.38% of patients had anemia, 20% had hypertension, 4.61% had history of previous caesarean section. Baby weight at time of birth was 2.5 to 3.5 kg in 67.70% of cases. 15.38% of patients required blood transfusion.Conclusions: A skilled obstetrician is required to take timely and proper decision in such cases and also to conduct cesarean section at second stage of labour

A prospective study of obstetric and gynaecological emergencies in a tertiary care hospital

Background: The management of obstetrics and gynaecological emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. The main aim of the study was to access the burden of surgical emergency and to study the course of management at a tertiary care hospital.Methods: This prospective study was carried out in the department of obstetrics and gynaecology, S. S. G. Hospital, Baroda for a period from January to December 2018.Results: A total of 73 patients presented to our emergency room who required urgent surgical intervention. All patients were resuscitated and surgery was done at earliest possible time. The age of patient ranged from 18 to 45 years.  About 75.8% of female presented with the complaint of acute abdomen, followed by 32.9% with bleeding per vaginum. 16.4% had vomiting, 6.8% with fever and 4.1% with mass per abdomen. In majority of cases a diagnosis of ruptured ectopic pregnancy (34 patients) was made, followed by PPH in 14 patients and 12 cases of rupture uterus. Four cases of torsion of ovarian mass and 3 cases of septic peritonitis were operated. The most common surgery performed was salpingectomy followed by subtotal obstetric hysterectomy. A mortality rate of 8.2% was noted.Conclusions: This study emphasized the great role of timely surgical intervention as lifesaving procedures. Skilled clinicians and immediate intervention in a tertiary care is the main-stay of the emergency case management and are indispensable for decreasing mortality and morbidity

A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial

Yoga may be effective in the reduction of PTSD symptomology. The purpose of this study was to evaluate the impact of a Kundalini Yoga (KY) treatment on PTSD symptoms and overall wellbeing. To supplement the current field of inquiry, a pilot randomized control trial (RCT) was conducted comparing an 8-session KY intervention with a waitlist control group. 80 individuals with current PTSD symptoms participated. Both groups demonstrated changes in PTSD symptomology but yoga participants showed greater changes in measures of sleep, positive affect, perceived stress, anxiety, stress, and resilience. Between-groups effect sizes were small to moderate (0.09–0.25). KY may be an adjunctive or alternative intervention for PTSD. Findings indicate the need for further yoga research to better understand the mechanism of yoga in relation to mental and physical health, gender and ethnic comparisons, and short- and long-term yoga practice for psychiatric conditions

Health Workers' Performance in the Implementation of Patient Centred Tuberculosis Treatment (PCT) Strategy Under Programmatic Conditions in Tanzania: A Cross Sectional Study.

Patient Centred Tuberculosis Treatment (PCT) is a promising treatment delivery strategy for Mycobacterium tuberculosis (TB). It aims to improve adherence to treatment by giving patients the choice of having drug intake supervised at the health facility by a medical professional or at home by a supporter of their choice. A cross-sectional survey was undertaken in three districts of Tanzania during October 2007, one year after PCT was rolled out nationally. Semi-structured questionnaires were used to assess whether key elements of the PCT approach were being implemented, to evaluate supporters' knowledge, to capture opinions on factors contributing to treatment completion, and to assess how treatment completion was measured. Transcripts from open-ended responses were analysed using framework analysis. Interviews were conducted with 127 TB patients, 107 treatment supporters and 70 health workers. In total, 25.2% of TB patients were not given a choice about the place of treatment by health workers, and only 13.7% of those given a choice reported that they were given adequate time to make their decision. Only 24.3% of treatment supporters confirmed that they were instructed how to complete patients' treatment cards. Proper health education was the factor most frequently reported by health workers as favouring successful completion of TB treatment (45.7%). The majority of health workers (68.6%) said they checked returned blister packs to verify whether patients had taken their treatment, but only 20.0% checked patients' treatment cards. The provision of choice of treatment location, information on treatment, and guidance for treatment supporters need to be improved. There is a requirement for regular re-training of health workers with effective supportive supervision if successful implementation of the PCT approach is to be sustained

Assessing Pharmacodynamic Interactions in Mice Using the Multistate Tuberculosis Pharmacometric and General Pharmacodynamic Interaction Models

The aim of this study was to investigate pharmacodynamic (PD) interactions in mice infected with Mycobacterium tuberculosis using population pharmacokinetics (PKs), the Multistate Tuberculosis Pharmacometric (MTP) model, and the General Pharmacodynamic Interaction (GPDI) model. Rifampicin, isoniazid, ethambutol, or pyrazinamide were administered in monotherapy for 4 weeks. Rifampicin and isoniazid showed effects in monotherapy, whereas the animals became moribund after 7 days with ethambutol or pyrazinamide alone. No PD interactions were observed against fast-multiplying bacteria. Interactions between rifampicin and isoniazid on killing slow and non-multiplying bacteria were identified, which led to an increase of 0.86 log10 colony-forming unit (CFU)/lungs at 28 days after treatment compared to expected additivity (i.e., antagonism). An interaction between rifampicin and ethambutol on killing non-multiplying bacteria was quantified, which led to a decrease of 2.84 log10 CFU/lungs at 28 days after treatment (i.e., synergism). These results show the value of pharmacometrics to quantitatively assess PD interactions in preclinical tuberculosis drug development