Definitive radiotherapy for locally advanced squamous cell carcinoma of the vulva and technical issues: a case report

This case report describes a complex radical 3D-Conformal Radiotherapy treatment planning, dosimetric issues and outcome of definitive treatment of un-resectable carcinoma of the vulvar in a 42-year old lady. The patient presented with large fungating mass of the vulva which was biopsy confirmed as Keratinizing Squamous Cell Carcinoma. Further staging investigation revealed locally advanced disease (T4), with bilateral inguinal lymph nodes involvement. There is no systemic metastasis or intra-pelvic nodes. The patient was seen by Gynae-Oncology team and the disease was deemed un-resectable without significant morbidity. She was treated to a total dose of 64.8Gy in 36 fractions over 7 weeks with concurrent weekly Cisplatinum in 2 phases. 3D-Conformal radiotherapy technique using the modified segmental boost technique (MSBT, large PA and small AP photon fields with inguinal electron matching) was used. TLD chips were used for in-vivo dose verification in phase 1 and 2 of the treatment. At completion of planned radiotherapy, patient had a complete clinical response, grade 2-3 skin toxicity, grade 2 rectal toxicity, and grade 2 dysuria Vulval Squamous Cell Carcinomas are very radiosensitive tumours and the skills of the treating Radiation Oncologist, Dosimetrists, Physicist, Radiation Therapist and also nurses is of foremost importance is ensuring good clinical outcomes

Effectiveness of Mediterranean diet on diabetic control and cardiovascular risk modification among patients with type 2 diabetes mellitus in Oman: a study protocol

Introduction: In the recent years, there is remarkable increased in the prevalence of Type 2 Diabetes Mellitus (T2DM) in Middle East countries including Oman. There is good evidence that Mediterranean Diet (MedDiet) is effective over diabetes control and several cardiovascular risk factors in different populations, with little compelling evidence among Omanis. This paper describes the protocol of a wait-list, open labelled, randomized control trial, with its main objective aimed to determine the effectiveness of Mediterranean Diet intervention on glycaemic control and cardiovascular risks among T2DM patients in Oman. Methods: A total of 140 eligible T2DM patients will be recruited. Participants in the intervention group will undergo a six-month MedDiet program comprising of different activities (individual dietary counseling, cooking classes, phone calls and social media messages) while the control group will continue with standard diabetes care. Data collection will be conducted at baseline, after three and six months. The 2 x 3 mixed-design ANOVA will be used to determine the mean changes in outcome variables over the full study period between the two groups. Discussion: Epidemiology studies on nutrition and health had focused on dietary pattern, which provides an opportunity to account for nutrient-nutrient interactions lately. Mediterranean Diet has produced consistent findings on its protective role in diabetes management, with little information on its effectiveness in population outside of Mediterranean basin, including Oman. The outcomes of current study will be used to inform community and health care professionals on the effectiveness and practically of MedDiet on diabetes management

Does Extract of Pleurotus sajor-caju affect Liver Enzymes and Histological Integrity?

Pleurotus sajor-caju (PSC) was believed to have both antihyperlipidemic and hepatoprotective activities. The present study aimed to investigate the effect of PSC on liver enzymes and histological integrity. This study used five groups of rats fed with ghee in the ratio 32g ghee per 68g pellet to induce hypercholesterolemia and one group was fed on cholesterol free basal diet. Rats treated with 100 mg/kg of PSC for a month was found to have an effect on the liver enzymes activities since plasma alkaline phosphatase (ALP) concentration in this group showed a significant reduction (P<0.05) and a higher percentage reduction (66.01%) as compared to 20 mg/kg-PSC and 200 mg/kg- PSC treatment groups. The plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) only showed a mild increased by 35.04% and 15.00% respectively in 100 mg/kg-PSC treatment group and there was no significant increased (P>0.05) found in these both AST and ALT concentrations. Atorvastatin treatment also showed reduction in ALP enzymes but no significant reduction (P>0.05) as compared to 100 mg/kg-PSC treatment group. On the other hand, plasma AST and ALT in 20 mg/kg of atorvastatin treatment were increased in percentage by 275.97% and 112.50% respectively indicated the adverse effects of statin in term of elevation of plasma enzymes activities. On the histological part, there was no significant finding in the micrograph study between treatment and hypercholesterolemic (HPC) liver rat. The micrograph of rat liver treated with 100 mg/kg PSC showed smooth and clear surface of hepatocytes compared to HPC group

Scanning Electron Microscopic Investigation of the Eviscerated Strands of Perhentian Island Bohadschia spp

As a defense reaction, the species Bohadschia grafeii and probably also another species, which we temporarily named as Bohadschia spp., eviscerate plenty of noodle-like threads which stick to the intruder’s body. These species belonging to the order holothuridae, are also known as ‘timun laut kuning’ and ‘timun laut batik’ amongst the local populace at the resort islands of Perhentian, Terangganu, Malaysia. The eviscerated materials are probably collagen-based materials exhibiting unique features when observed under the scanning electron microscope (SEM). The threads, measuring 0.3 to 2.5 mm in diameter with variable length are white in colour, shiny and are sticky in nature. Under the SEM, the features which confer the ability for the threads to stick to many different types of surfaces are clearly displayed. The presence of cup-like structures distributed along the threads do provide possible explanation of the possible vacuum suctional ability that makes the threads stick fast to almost any surface. The role of this defense system, at least in the two species mentioned here, has not been described earlier

Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia

Objective:The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community. Methods: Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT). Results: Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc. Conclusion: Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis

Cervical Ectopic Pregnancy: A Management Dilemma.

A 28-year-old G3P1+1 at 6 weeks period of amenorrhea with a previous Caesarean section presented with per vaginal bleeding. A cervical ectopic pregnancy was confirmed by a transvaginal scan. An intramuscular methotrexate was given followed by intracervical route due to poor decline of the serum βHCG. However, due to persistent increment of serum βHCG, an additional four doses of intramuscular methotrexate with folinic acid rescue were administered and she responded well to the regime. Unfortunately, following the last dose, she developed an episode of excessive per vaginal bleeding which required suction and curettage of the cervical canal. A Foley‘s catheter balloon was placed intracervically as a tamponade and the bleeding was successfully arrested

Effect of feeding fractionated RBD palm stearin on milk yield and quality of dairy cattle

Energy intake of dairy cows is important during the peak of milk production to maintain consistency of milk yield. To overcome energy deficiency, diet with high energy density is required for lactating dairy cows which can be enhanced by incorporating fats. Therefore a feeding trial was conducted to determine the effects of supplementing fat with fractionated RBD Palm Stearin on feed consumption, milk yield, composition and fatty acid profile of dairy cows. A total of 35 lactating dairy cows in early and mid-lactating periods were used in this trial. The trial was conducted for 12 wk and individual milk yield was recorded twice daily. Daily milk yield was increased (p<0.05) from 8.18 l for diet without fat to 8.42 and 8.32 l of milk yield per day, for inclusion of 5% and 2.5% fractionated RBD Palm Stearin, respectively

Application of Mediterranean diet in cardiovascular diseases and Type 2 diabetes mellitus: motivations and challenges

Objective: Cardiovascular disease (CVD) is the leading cause of disability and death in many countries. Together with CVD, Type 2 diabetes mellitus (T2DM) accounts for more than 80% of all premature non-communicable disease deaths. The protective effect of the Mediterranean diet (MedDiet) on CVD and its risk factors, including T2DM, has been a constant topic of interest. Notwithstanding, despite the large body of evidence, scientists are concerned about the challenges and difficulties of the application of MedDiet. This review aims to explore the motivations and challenges for using MedDiet in patients with CVD and T2DM. Design: An electronic search was conducted for articles about MedDiet published in PubMed, ScienceDirect, Scopus, and Web of Science up to December 2021, particularly on CVD and T2DM patients. From a total of 1536 studies, the final eligible set of 108 studies was selected. Study selection involved three iterations of filtering. Results: Motivation to apply MedDiet was driven by the importance of studying the entire food pattern rather than just one nutrient, the health benefits, and the distinct characteristics of MedDiet. Challenges of the application of MedDiet include lacking universal definition and scoring of MedDiet. Influences of nutritional transition that promote shifting of traditional diets to Westernized diets further complicate the adherence of MedDiet. The challenges also cover the research aspects, including ambiguous and inconsistent findings, the inexistence of positive results, limited evidence, and generalization in previous studies. The review revealed that most of the studies recommended that future studies are needed in terms of health benefits, describing the potential benefits of MedDiet, identifying the barriers, and mainly discussing the effect of MedDiet in different populations. Conclusions: In general, there is consistent and strong evidence that MedDiet is associated inversely with CVD risk factors and directly with glycemic control. MedDiet is the subject of active and diverse research despite the existing challenges. This review informs the health benefits conferred by this centuries-old dietary pattern and highlights MedDiet could possibly be revolutionary, practical, and non-invasive approach for the prevention and treatment CVD and T2DM