Few advances have been made in overall survival for glioblastoma multiforme (GBM) in more than 40 years. Here, we report the case of a 38-year-old man who presented with chronic headache, nausea, and vomiting accompanied by left partial motor seizures and upper left limb weakness. Enhanced brain magnetic resonance imaging revealed a solid cystic lesion in the right partial space suggesting GBM. Serum testing revealed vitamin D deficiency and elevated levels of insulin and triglycerides. Prior to subtotal tumor resection and standard of care (SOC), the patient conducted a 72-h water-only fast. Following the fast, the patient initiated a vitamin/mineral-supplemented ketogenic diet (KD) for 21 days that delivered 900 kcal/day. In addition to radiotherapy, temozolomide chemotherapy, and the KD (increased to 1,500 kcal/day at day 22), the patient received metformin (1,000 mg/day), methylfolate (1,000 mg/day), chloroquine phosphate (150 mg/day), epigallocatechin gallate (400 mg/day), and hyperbaric oxygen therapy (HBOT) (60 min/session, 5 sessions/week at 2.5 ATA). The patient also received levetiracetam (1,500 mg/day). No steroid medication was given at any time. Post-surgical histology confirmed the diagnosis of GBM. Reduced invasion of tumor cells and thick-walled hyalinized blood vessels were also seen suggesting a therapeutic benefit of pre-surgical metabolic therapy. After 9 months treatment with the modified SOC and complimentary ketogenic metabolic therapy (KMT), the patient’s body weight was reduced by about 19%. Seizures and left limb weakness resolved. Biomarkers showed reduced blood glucose and elevated levels of urinary ketones with evidence of reduced metabolic activity (choline/N-acetylaspartate ratio) and normalized levels of insulin, triglycerides, and vitamin D. This is the first report of confirmed GBM treated with a modified SOC together with KMT and HBOT, and other targeted metabolic therapies. As rapid regression of GBM is rare following subtotal resection and SOC alone, it is possible that the response observed in this case resulted in part from the modified SOC and other novel treatments. Additional studies are needed to validate the efficacy of KMT administered with alternative approaches that selectively increase oxidative stress in tumor cells while restricting their access to glucose and glutamine. The patient remains in excellent health (Karnofsky Score, 100%) with continued evidence of significant tumor regression.

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A novel Ag(I) citrate complex with ethyl-3-quinolate (Et3qu) was synthesized. Its structure was confirmed using X-ray single crystal to be [Ag(Et3qu)2(citrate)]. It crystallized in the Triclinic crystal system and P-1 space group with unit cell parameters of a = 8.6475(2) Å, b = 11.4426(3) Å, c = 15.2256(3) Å, α = 73.636(2)°, β = 79.692(2)° and γ = 86.832(2)°, while the unit cell volume was 1422.19(6) Å3. In the unit cell, there are two [Ag(Et3qu)2(citrate)] molecules and one unit as the asymmetric formula. The molecular structure comprised one Ag(I) coordinated with two Et3qu molecules via two almost equidistant Ag-N bonds and one citrate ion acting as a mono-negative monodentate ligand via a short Ag-O bond (2.5401(14) Å). Hence, Ag(I) is tri-coordinated and has a highly distorted triangular planar coordination geometry which is more like to be described as a slightly distorted T-shape. The supramolecular structure of the [Ag(Et3qu)2(citrate)] complex was analyzed using Hirshfeld calculations. The H···H (39.3–40.1%), O···H (33.2-34.0%), C···C (9.1–9.5%) and C···H (7.2–7.4%) contacts shared significantly in the packing of the studied Ag(I) complex. The antimicrobial and anticancer activities of the Ag(I) complex were investigated. The [Ag(Et3qu)2(citrate)] complex has broad-spectrum antimicrobial activity specifically against the fungus A. fumigatus. In addition, the IC50 values of 1.87 ± 0.09 µg/mL and 0.95 ± 0.06 µg/mL against the breast MCF-7 and lung A-549 cell lines, respectively, revealed the potent anticancer activity of the [Ag(Et3qu)2(citrate)] complex compared to the free Et3qu (IC50 = 30.64 ± 1.98 and 22.89 ± 1.48 µg/mL, respectively).

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the second cause of cancer related mortality. Treatment options for patients with metastatic CRC (mCRC) expanded during the last two decades, with introduction of new chemotherapeutic and targeted agents. Egypt is a lower middle-income country; Egyptian health care system is fragmented with wide diversity in drug availability and reimbursement policies across different health care providing facilities. We report the results of consensus recommendations for treatment of patients with metastatic colorectal cancer developed by Egyptian Foundation of Medical Sciences (EFMS), aiming to harmonize clinical practice through structured expert consensus-based recommendations consistent with the national status. EFMS recommendations could be utilized in other countries with similar economic status. Methods: EFMS recommendations were developed using a modified Delphi process, with three rounds of voting till the final recommendations were approved. A non-systematic review of literature was conducted before generating the provisional statements. Content experts were asked to vote on some recommendations in two different resource groups (restricted resources and non-restricted resources). External review board of experts from a low income and lower-middle countries voted on the applicability of EFMS recommendations in their countries. Results:The current recommendations highlighted the discrepancy in health care between restricted and non-restricted resources with expected survival loss and quality of life deterioration. Access to targeted agents in first line is very limited in governmental institutions, and no access to agents approved for third line in patients who failed oxaliplatin and irinotecan containing regimens for patients treated in restricted resource settings. Conclusion: Management of mCRC in developing countries is a challenge. The currently available resource-stratified guidelines developed by international cancer societies represent a valuable decision-making tool, adaptation to national status in each country based on healthcare system status is required.

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Two single nucleotide polymorphisms (SNPs) of matrix metalloproteinase (MMPs) 3 and 9 are functionally implicated in the progression of various types of cancer, including breast cancer (BC). However, the roles of these SNPs remain controversial. In addition, they also vary between one population and another. Therefore, the present study aimed to investigate the possible association between MMP3-1171 5A/6A and MMP9-1562 CT SNPs and the risk of BC among Egyptians, and to elucidate the alteration of MMP3 and MMP9 gene expression in patients with BC. The present case-control study enrolled 162 patients with BC and 146 control subjects. Restriction fragment length polymorphism-PCR was performed for analysis of the selected SNPs, gene expression of MMP3 and MMP9 was also assessed in 50 patients and 50 control subjects by reverse transcription-quantitative PCR. The frequencies of 5A/6A genotype and 5A allele of MMP3 were significantly higher in patients with BC compared with in healthy subjects. On the other hand, the distributions of MMP9 genotypes and alleles were not significantly different among patients and healthy subjects. Compared with healthy subjects, the expression levels of the two genes were found to be upregulated in patients with BC. Therefore, the present study indicated that MMP3-1171 5A/6A SNP, not MMP9-1562 C>T SNP may be a risk factor for developing BC among Egyptian females.

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Background:The majority of lung cancer cases are non-small cell lung cancer (NSCLC). MicroRNAs (miRNAs) are small non-coding molecules that control target gene(s) expression. Aims: Identification of circulating levels of miRNA-21, 126, 513a, and 98 in NSCLC and assessment of their diagnostic and predictive values. Material and Methods: In this study, the levels of miRNA-21, 126, 513a, and 98 were evaluated in 19 NSCLC patients and 11 healthy individuals. miRNAs were extracted from patients and healthy control whole blood samples and cDNA was synthesized with the specific primers for each miRNA, real-time quantitative polymerase chain reaction (RT-qPCR) was used to assay the expression pattern of miRNAs. Results:The circulating levels of miRNA-21, 126, and 513a were significantly up-regulated in NSCLC patients as compared to the healthy subjects. Of interest, the circulating levels of these miRNAs were about twice higher in stage IV patients than stage III patients. miRNA-513a showed the highest diagnostic accuracy (AUC = 0.942, specificity = 100, and sensitivity = 85.7) and sensitivity was improved when in combination with miRNA-21 (AUC = 0.929, specificity = 90.91, and sensitivity = 92.8). All studied miRNAs showed clear changes during the treatment of NSCLC patients with the platinum regimen. Conclusions: miRNA-21, 126, and 513a may be considered as candidate diagnostic circulating biomarkers in NSCLC as well as a potential predictive biomarkers for the response to the platinum regimen. miRNA-513a showed the highest diagnostic accuracy for distinguishing NSCLC patients from healthy controls.