Introduction: Type I diabetes mellitus patients often complain of hunger and suboptimal blood glucose levels. Proper protein distribution might help to improve glucose control and ultimately, carbohydrate distribution. Case presentation: A nine-year-old boy (herein the patient) newly diagnosed with Type I diabetes mellitus with diabetic ketoacidosis, presented nocturia, polydipsia, loss of weight and lethargy. During admission, the patient was dehydrated and had decompensate metabolic acidosis with glycated hemoglobin (HbA1c) 14.5%, random blood sugar 26.2 mmol/dL, and ketone 3.2 mmol/dL. The patient was started on insulin therapy and referred to a dietitian on the 2nd day of admission. Although patient complied with the dietitian's plan, his glucose level remained suboptimal and he complained of hunger immediately after meals. Insulin dose and activity level remained same at this moment. Whilst keeping the protein intake constant, protein exchanges were redistributed into snacks and main meals. The patient felt satiety and his blood glucose started to optimise. Pairing protein-rich foods with carbohydrates can help to slow the rise in blood glucose because protein causes slower stomach emptying and helps prevent sharp spikes in blood glucose and takes the edge off hunger. Conclusion: This reported case showed proper protein distribution with even carbohydrate distribution can help to improve glucose control and satiety in type I diabetic mellitus. It is recommended that further investigations be conducted to provide more concrete evidence on the role of protein distribution in blood glucose control of type I diabetes mellitus.

ntroduction: Enhanced recovery after surgery (ERAS) protocols are multidisciplinary perioperative care aimed to achieve early recovery after surgery by maintaining preoperative organ function and reducing the surgical induced stress response. Case presentation: A 79-year-old female patient with Transverse Colon Adenocarcinoma, elective admitted for colon resection. Patient was cachexia with weight 33 kg; loss of 7 kg within 1 month; PGSGA score 14 (severe malnourished); Albumin 30 g/L. She experienced very poor oral intake for past 1 month with intake of 450 kcal/day and 15 g/day protein. Carbohydrate loading with 100 g carbohydrate as evening drink and 50 g carbohydrate 3 hours pre-operation. Clear fluid (carbohydrate plus whey protein drink) was allowed on the first day of operation (POD). Regular diet was started on the POD3 since patient tolerated 500 ml of clear fluid. Patient tolerated well with solid food on POD4 and allowed discharged on POD5. As summary, length of hospital stay 5 days 2 hours, ambulation length 20 hours, length of clear fluid toleration 18 hours, length of solid food toleration 4 days and length of gastrointestinal function (flatus & bowel open) 4.5 days. Discussion: Advanced age is a proven risk factor of post-operative complications. Shorter hospital stay was found associated with a lower risk of post-operative complications. Length of hospitalization after colorectal surgery does not significantly differ between younger and older age groups of the patients. Conclusion: ERAS showed good overall outcome even elderly. Good quality of care at home is required and crucial as well after quicker discharged.

Mounting evidence indicates that melatonin has possible activity against different tumors. Pazopanib is an anticancer drug used to treat renal cell carcinoma (RCC). This study tested the anticancer activity of melatonin combined with pazopanib on RCC cells and explored the underlying mechanistic pathways of its action. Methods: The 786-O and A-498 human RCC cell lines were used as cell models. Cell viability and tumorigenesis were detected with the MTT and colony formation assays, respectively. Apoptosis and autophagy were assessed using TUNEL, annexin V/propidium iodide, and acridine orange staining with flow cytometry. The expression of cellular signaling proteins was investigated with western blotting. The in vivo growth of tumors derived from RCC cells was evaluated using a xenograft mouse model. Results: Together, melatonin and pazopanib reduced cell viability and colony formation and promoted the apoptosis of RCC cells. Furthermore, the combination of melatonin and pazopanib triggered more mitochondrial, caspase-mediated, and LC3-II-mediated autophagic apoptosis than melatonin or pazopanib alone. The combination also induced higher activation of the p38 mitogen-activated protein kinase (p38MAPK) in the promotion of autophagy and apoptosis by RCC cells than melatonin or pazopanib alone. Finally, tumor xenograft experiments confirmed that melatonin and pazopanib cooperatively inhibited RCC growth in vivo and predicted a possible interaction between melatonin/pazopanib and LC3-II. Conclusion: The combination of melatonin and pazopanib inhibits the growth of RCC cells by inducing p38MAPK-mediated mitochondrial and autophagic apoptosis. Therefore, melatonin might be a potential adjuvant that could act synergistically with pazopanib for RCC treatment.

Introduction: Malnutrition is common among cancer patients and it is reported in a significant proportion of patients with gynaecological cancer (GC). The aim of this study was to determine the association between quality of life (QOL) and hand grip strength (HGS) among malnourished GC outpatients in the National Cancer Institute (NCI). Methods: This study was carried out in a Multidisciplinary Clinic of NCI. HGS was measured using Jamar Hand Dynamometer. Nutritional status was assessed using the scored Patient-Generated Subjective Global Assessment (PGSGA). QOL was measured using the validated European Organisation for Research and Treatment of Cancer Questionnaire (EORTC-QLQ C30). Results: A total of 69 patients were selected for the study. Fifty eight (84.1%) were classified as moderately malnourished or at risk of malnutrition (PG-SGA B) and 11 (15.9%) were classified as severely malnourished (PG-SGA C). There was a moderate, significant positive relationship between HGS and functional status (rs=0.275, p=0.022) observed in this study. Besides, in malnourished GC patients with low HGS, results indicated that they had problems with social functioning as well (r=0.255, p=0.035). Appetite was suggested as a predicting factor for low HGS among malnourished GC patients (F=12.253, p=0.001). Conclusion: HGS is a simple objective indicator of functionality and is, therefore, a valid item to be measured when assessing QOL of malnourished GC outpatients.

Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes.

Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional supplements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain.