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| HEALTH & FITNESS |
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Liver cancer — a global challenge Learn to live with lupus Encourage this disorganised child
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Liver cancer — a global challenge Liver cancer is a major public health concern and its incidence is increasing in India. Of the new cases diagnosed each year globally , 80% of the cases occur in developing countries. Most Asian countries are in an intermediate or high zone. Most patients present with advanced disease and carry a poor prognosis. Those at high risk of liver cancer include patients with hepatitis B, hepatitis C, alcoholic cirrhosis, and non-alcoholic steatohepatitis . More than 80% of liver cancers develop in Asian and African countries where between 40% and 90% of liver cancers are attributed to chronic hepatitis B virus infection. Hepatitis C infection is the leading cause of liver cancer in Europe and the United States. Chronic hepatitis B [HBV] is a serious global health issue. Worldwide approximately 350 million people are chronically infected resulting in about one million deaths annually from liver cancer, cirrhosis, or liver failure. An estimated 170 million people worldwide are infected with hepatitis C (HCV). Asians have the highest incidence of chronic hepatitis B virus. China and India together have an estimated 123 million people chronically infected with hepatitis B virus and 59 million chronically infected with hepatitis C virus accounting for almost 50% of all B and C viral infections worldwide. Hepatitis B and C, and alcohol are the most common causes of liver disease in India that lead to liver cancer. The long-term liver impact of hepatitis virus infection is variable from minimal changes to chronic hepatitis , extensive fibrosis, cirrhosis and liver cancer. Screening and surveillance strategies have been developed to detect cancer at an earlier stage when curable treatment can be offered. High risk category individuals — hepatitis B or C, and alcoholics —should get screened regularly. A combination of alpha feto protein and ultrasonography examination has been used as a tool for liver cancer detection in high risk individuals. In Taiwan, the surveillance interval in cirrhotic patients is 3-6 months whereas it is 6-12 months in patients with chronic liver disease. American Association for Liver Diseases guidelines recommend surveillance for high risk groups using an ultrasound at 6-12 months intervals. When screening ultrasound detects an abnormal lesion, liver cancer can be diagnosed by its unique findings on triple phase contrast enhanced CT, or on MRI. Monitoring individuals with hepatitis markers and family history could help to identify cancer at an earlier stage and potentially reducing mortality.Individuals with a positive family history of liver cancer have three times higher risk of developing cancer. Reports have shown that the mortality rate is significantly lower in the screened group. Prevention of liver cancer is possible. Prevent the occurrence of hepatitis B and C infection, and reduce alcohol consumption. The spread of hepatitis B can be prevented by vaccination. Vaccination against hepatitis B virus is the mainstay of hepatitis B prevention. Extensive vaccination campaigns among the population is a must. Primary prevention with universal hepatitis B vaccination has demonstrated a reduction in liver cancer in several countries. Prevention of hepatitis C infection requires the reduction of risky behaviour and improvement of hygiene. Most patients with liver cancer have underlying liver disease and require careful evaluation because of the potential for post-resection liver decompensation. Symptoms of liver cancer are commonly related to those of their chronic liver disease and include pain in the upper abdomen, a lump or feeling of heaviness, anaemia and weight loss. There are many and varied approaches to treatment of patients with liver cancer. Liver cancer treatment involves management of two disease processes — liver cancer and underlying liver disease. The simultaneous presence of cirrhosis complicates the management of cancer. The surgeon has to consider tumour specific factors (location, number, size), and liver-specific factors (degree of liver fibrosis, cirrhosis, size of future liver remnant). Therapy for liver cancer is complex and may involve resection, liver transplantation; radiology-based liver directed therapies, and systemic chemotherapeutic and targeted agents. Surgeons need to be aware of the role of intra-arterial regional therapy for unresectable cancer as well as ‘bridge therapy’ before resection/transplantation. Pre-operative portal vein embolisation has made resection possible for the subset of patients with anticipated small liver remnant. Embolic agents represent a therapeutic option in patients with advanced disease. Selective internal radiation therapy is a relative new modality for treating non-resectable cancer — radioembolic microspheres are selectively delivered in the tumour tissue. A new era of molecular targeted approaches is emerging. Liver transplant treats both liver cancer and the underlying liver disease. Concluding, screening is recommended for high risk category individuals. Vaccination against hepatitis B virus may reduce the risk of liver cancer in future. Identification of high risk groups for active surveillance, effective antiviral treatment for chronic hepatitis B and C infection, and early detection and prompt treatment should decrease the mortality rate. The most appropriate therapy depends on the functional status of the liver. The writer is a former
Professor and Head, Department of General Surgery, PGI, Chandigarh. |
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Learn to live with lupus As knowledge is power, you must know about lupus so that you can fight it with mental and physical power. It is a fatal, incurable, exhausting and unpredictable chronic illness. It is a long-term autoimmune disorder that may affect the skin, joints, kidneys, brain and other organs. Symptoms vary from person to person and flare up or go into recession. But almost every patient has joint pain and swelling. The body’s immune system mistakenly attacks healthy tissues presuming it to be a foreign body. This leads to chronic (persistent or long lasting) inflammation. It is more common in women than men. It may occur at any age but is more common between age 10 and 50 years. It can affect neonates also. Its cause is not fully known. Sometimes it is drug-induced or due to foreign substances such as bacterial, virus stress, adulteration, genetic, etc. Other symptoms include chest pain on deep breadth, fatigue, general ill feeling, hair loss, mouth sores, swollen lymph nodes, sensitivity to sunlight, skin rash, etc. This rash gets worse in sunlight, may also be widespread, fingers that change colour when cold (Raynaud’s phenomenon). There may be numbness, headaches, tingling sensation, vision problems, personality changes etc. Tuberculosis is also likely to develop. It is diagnosed as lupus if four out of 11 signs of the disease are present. All this results in anxiety and depression. Severe or life-threatening symptoms are hemolytic anaemia, destruction of red blood cells lung-related problems, kidney disease or disturbance in the central nervous system. Treatment for thinning of bones (osteoporosis) is required. Sexual intercourse can be done depending on your fatigue level. Pregnancy can be carried on successfully if there is no severe kidney or heart disease. However, presence of (SLE) Systemic Lupus Erythrometosus (SLE) antibodies may increase the risk of pregnancy loss. Some people with SLE have abnormal deposits in the kidney cells leading to lupus nephritis which eventually results in kidney failure and need dialysis or kidney transplant. SLE also causes blood clots in legs (deep vein thrombosis) or lungs (pulmonary embolism). Living with lupus is not an easy task. Despite it, have jest for life and put up a spirited fight. The strength lupus people can develop while battling their illness is the positive side of lupus. They even become the teacher of their peers by coming through with all small and big problems. Do not be put off by this challenge. Self-assurance and self-respect is very important in public interaction. Do not miss medicines. When there is change in medicine its side-effects should be noticed. You should be aware of the flare-up period and remain calm, take rest if fatigued. Go along the daily routine slow and steadily but with prayer, which will make you positive and strong physically, mentally and emotionally. If you are working, balance between work and rest. The unpleasant weight gain due to medicines, the hair loss, the stomach bloating makes you look unattractive but raise your confidence and keep a fitness regime. Dress up and make up well to get compliments to boost your self-esteem. Work sincerely and come out with creative results for the sense of achievement, self-confidence and self-assurance. Receive support from others and in return help others. The writer is associated with the PGI, Chandigarh. |
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Encourage this disorganised child Harry Potter star Daniel Radcliffe revealed he suffered from dyspraxia, meaning he sometimes still had trouble tying his shoe laces. The star in The Telegraph (UK), admitted he became an actor partly because his dyspraxia meant he was not successful at school. There are about 10% people who have some degree of dyspraxia while approximately 2% have it in severe form in. If an average classroom has 30 children, there is probably one child with dyspraxia in almost each classroom. Dyspraxia is a disorder of motor planning and/or execution with no significant or normal findings on neurological examination. It is a disorder of the higher cortical process and there may be associated problems of perception (how the child interprets what he sees and hears), use of language and putting thoughts together. The English medieval word dyspraxia is derived from the Greek word duspraxia. This word comes from the Greek word paraxis which emerged from an older greek word prassein meaning “to pass through, experience practice.” Developmental dyspraxia is an immaturity of the recognition of movement. The brain does not process information in a way that allows for a full transmission of neuronal messages. A child with dyspraxia finds it hard to plan what to do, and how to do it. Planning dyspraxia means when there are difficulties with planning a sequence or order of coordinated movements, actions that involve manipulations of objects. Executive dyspraxia is noticed when there are difficulties with providing what to do but being unable to do it, moving from one activity to another and copying actions. How would I recognise a child with dyspraxia ? *
He/she may take longer than other children to sit, crawl (some never go through crawling stage), walk, speak, stand, become potty trained, build up
vocabulary. * Problems performing subtle movements such as tying shoe laces, doing up buttons and zips, using cutlery, handwriting and getting dressed. *
Problems carrying out play ground activities such as jumping, catching a ball, kicking a ball, hopping and skipping. *
Problem with colouring, drawing, using scissors. * Problem with processing thoughts. *
Difficulty in learning new skills. In later childhood * Tries to avoid sports and physical activity. *
Learning one-on-one basis, but is nowhere near other kids in his/her class. *
Finds mathematics and writing are difficult. * Is badly organised. Tips to help a disorganised child For teachers in school * Comparison is disastrous. Never allow a child with dyspraxia to be compared to an able child. *
Praise every effort and every small accomplishment. * Allow extra time during teaching. For parents at home *
By early identification * Practice skills with your child * Encourage activities to enforce coordination *
Talk through activities * Help them learn necessary sound skills. *Taking help of occupational therapist and speech and language therapist. *
By perceptual motor learning. Dyspraxic children have difficulty in learning new skills. While other children may do this automatically, a child with dyspraxia takes longer. Encouragement, and consultation with occupational and speech therapist help enormously. The writer is a consultant paediatrician based in Jaipur
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Health Notes London: Researchers have found that new mothers have a better memory — the findings that counter the belief that women experience a decline in memory and cognitive function after they have children. Suddenly becoming scatty and forgetful has long been seen as part and parcel of becoming a mother. But scientists say so-called 'baby brain' may be a myth and, in fact, having a child may actually improve a woman's memory. In a series of experiments, new mothers scored better on tests of visuospatial memory — the ability to perceive and remember information about their surroundings — compared with women who didn't have children. — ANI Words as bad as sticks and stones for kids’ development
London: The children’s rhyme “Sticks and stones will break my bones but names will never hurt me” is not true, say child abuse experts. They claimed verbal abuse could be just as harmful to a child’s development as a physical attack, the Daily Express reported. “Yelling at a child every day and giving the message that the child is a terrible person, and that the parent regrets bringing the child into this world, is an example of a potentially very harmful interaction,” said Dr Harriet MacMillan, professor of psychiatry at McMaster University in Canada. This form of psychological abuse can occur in many types of families, but is more common in homes with multiple stresses, including family conflict, mental health issues, physical violence, depression or substance abuse. Her study appeared in the journal
Paediatrics. — ANI
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Liver cancer is a major public health concern and its incidence is increasing in India. Of the new cases diagnosed each year globally , 80% of the cases occur in developing countries. Most Asian countries are in an intermediate or high zone. Most patients present with advanced disease and carry a poor prognosis.
