Tra Zehnder : iban woman patriot of Sarawak

There has been a resurgence of interest in the use of the life history method in social science research. This particular qualitative research method has grown in significance with the realization that an understanding of history and broader societal changes through people's 'lived experiences' is important and often much neglected. An individual is not an isolated entity but is enmeshed in a network of social relations and institutions. Thus, by placing the life of an individual centre-stage, the intimate and the personal reveal the public and the political at a specific point in history. The feminist notion of "the personal is political" takes on a new meaning in the use of the life history method. In choosing to write the life history of Philomena Tra Zehnder we are informed by our feminist stance of highlighting women's lives and giving space to the life stories of minority groups which are often sidelined and ignored. This book is the first of its kind to be written about an Iban woman leader in Sarawak. This is not merely to valorize Dato Seri Philomena Tra Zehnder but it is hoped that in reading her life story, one would also have a glimpse of the historical developments connected with her life and times

High incidence of metastatic disease in primary high grade and large extremity soft tissue sarcomas treated without chemotherapy

BACKGROUND: The risk of metastasis and the survival in patients with primary extremity soft tissue sarcomas is worse when tumour size is large and the grade of malignancy is high. Such tumours may receive chemotherapy and/or radiation therapy (RTX) for optimising local control. Irradiation can either be applied preoperatively or after tumour resection. The question arises if the kind of RTX in the absence of chemotherapy influences the outcome concerning local control, metastatic disease, survival and complications. METHODS: We retrospectively reviewed the clinical outcome of 233 patients with a primary extremity soft tissue sarcoma treated between 1990 – 2000 with a mean follow-up of 35.8 (4–120) months in our institute. 41 patients had high grade, deep and large tumours (>8 cm), an AJCC stage III (no evidence of metastasis prior to treatment) and were treated with limb salvage surgery and irradiation but stayed without additional chemotherapy. Two groups of patients were compared: the first group received postoperative RTX after tumour resection (n = 33); the second group was treated with preoperative RTX (n = 8). Both groups did not differ concerning clinical parameters. We analysed primary and secondary outcomes. RESULTS: 56% (23/41) of the population developed metastatic disease, 24% (10/41) local recurrence. The risk of metastasis was higher in the group with preoperative irradiation (p = 0.046). The overall (p = 0.0248) and relapse free survival (p = 0.104) were worse in this group. The delay to tumour resection amounted 8 weeks on average in the preoperative group. Local control was not different (p = 0.38) in both study groups. Wound infections and other combined therapy related complications were equally distributed (p = 0.22). CONCLUSION: Without chemotherapy there remains a high risk of metastasis in AJCC grade 3 patients. In high risk patients treated without chemotherapy the elapsed time to tumour resection after preoperative radiation might contribute to the development of metastasis. This outcome may support the thesis that a combination of RTX and offensive multimodal treatment protocols is advantageous in such a subset of patient

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Agrarian change and gender relations the case of Batang Ai Resettlement scheme, Sarawak : A brief summary

The aim of the study was to examine how gender relations amongst the Iban had been affected by agrarian changes in Batang Ai. The agrarian changes in Batang Ai have largely been the result of the siting of a hydroelectric dam project in the area. This meant a transfer of subsistence hill paddy farmers to a resettlement scheme where cash crops were cultivated on a plantation basis. Cash compensations were paid to the settlers for the loss of their land, crops and other immovable properties which were inundated

Courtship, marriage and family in Sarawak

Sarawak’s population of 2.4 million consists of the Iban, Chinese, Malay, Bidayuh, Orang Ulu and Melanau in that order of demographic size. The classification of Orang Ulu alone includes the Kayan, Kenyah, Kelabit, Lun Bawang, Punan, Penan, Murut, Kedayan and a host of other smaller communities. It is said that there are at least 27 different ethnic groups but no one is really sure1 The complexity of such a multiethnic population has led some to say that Sarawak is an anthropologist’s paradise or nightmare depending on how one looks at it. It has a rich history of research where anthropologists documented the indigenous cultures and customs dating back to pre colonial times. As a result, we have much historical information on the family and kinship structures of the various indigenous groups but far less is known of the contemporary family. In this chapter, I have tried to piece together whatever little there is to try to understand the changes that have occurred. In order to do this, we have to begin with the past. Although I have set up the following sections as a contrast between the past and the present, it is more accurate to talk of continuity and change. Present day Sarawak, is after all a land which encompasses the full range of communities from the nomadic hunter-gatherer Penan in the hinterland to the globetrotting elites in the cities. It is therefore not my intention to present a dichotomous view but merely as a comparative especially in the light of rapid socio-economic transformation in Sarawak. However, the focus of my discussion of the past would be on the indigenous communities in rural Sarawak