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World Cancer Day, a day to renew vow to implement preventable strategies in India

[email protected] (Agencies)
February 4, 2017

New Delhi, Feb 4: World Cancer Day is being observed today (February 4) to raise cancer awareness and to encourage its prevention, detection and management.

CancerCancer accounts for more deaths worldwide than AIDS, malaria, and tuberculosis combined.

According to the World Economic Forum (WEF),"Cancer is among one of the three greatest risks to the global economy".

In India, cancer is one of the 10 leading causes of deaths in India and is an increasing public health challenge. With a prevalence of three million and annual incidence of one million, the statistics are alarming. It kills around five lakh people annually. In 2011, the UN resolution declared 4 key strategies to curb rising burden of cancers - tobacco control, controlling unsafe use of alcohol, obesity control and better nutrition.

Dr Vedant Kabra, Director of Surgical Oncology, Fortis Memorial Research Institute, Gurugram and a Voice of Tobacco Victims (VoTV) patron, says, "To have a clean and safe campus is every child's right. We must work on preventable strategies along with the treatments. It is a misery to see youngsters impacted by tobacco use and families getting destroyed mentally, financially and socially due to cancers."

Dr.Kabra further elaborates that "Hazards of tobacco are unlimited. There's no body part which is not affected by it. Smokeless tobacco contains nicotine, which is highly addictive. There are 3095 chemical components in tobacco, among them 28 are proven carcinogen. The major and most abundant group of carcinogens is the tobacco-specific N-nitrosamines (TSNA) and N-nitrosoamino acids."

"The nitrosamine level is directly related to the risk of cancer. Scientific evidence has established that tobacco chewing causes cancer of mouth, oesophagus (food pipe), larynx and pharynx (throat), pancreas, stomach, kidney and lung. It can also cause high blood pressure and other life threatening cardiovascular conditions like myocardial ischemia (heart attack), brain stroke etc. The use of smokeless tobacco during pregnancy can cause still birth, low birth weight, premature delivery, anaemia of mother and several complications during delivery," he adds.

As per the Global Adult Tobacco Survey (GATS) released by the MoHFW (2010), around 43 lakhs people above the age of 15 in Haryana (i.e. one in every four individual) are consuming tobacco in some or the other form. One-third of them will be diseased by the serious illnesses such as cancer, heart diseases, lung cancers among others and will die premature deaths.

Dr.Pankaj Chaturvedi, Professor Surgical Oncology, Tata Memorial Hospital, said, "It is a mammoth task to improve the nutritional status of a nation of one billion people. However, importantly control on tobacco / areca nut / alcohol / junk food is well within the reach of our policy makers."

While the cancer causing effects of tobacco are well known, most are still unaware of harmful effects of Alcohol, areca nut and obesity. The only way to discourage their usage is to strictly implement the Cigarette and Tobacco Product (COTPA) Act that aims to prohibit smoking in public places, prohibit sale to minors, stop direct and indirect advertising.

In India, every year in India, around one million new cancer cases are diagnosed and around 600,000 to 700,000 people die from cancer. In a report of April 2014, around two-fifths (40 percent) of all cancers in India are attributable to tobacco use and the economic costs of illness and premature death due to tobacco consumption exceed combined government and state expenditure and state expenditure on medical and public health, water supply and sanitation[i].

In India, 5500 children initiate tobacco use every day. Indeed, a very alarming statistic. A very effective strategy to prevent the 90 percent of oral cancers and 40 percent of all cancers is controlling the initiation of tobacco from childhood. Implementation of Section 4 & 6 of the Cigarettes and Other Tobacco Products Act (2003) would leave children with no access to tobacco products and have a clean and safe campus. If we make youngsters aware right from the childhood about the hazards of tobacco, the initiation rates would be very less thereby preventing these cancers.

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Agencies
June 11,2020

The World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus said that more research needs to be done to better understand the extent to which COVID-19 is being spread by people who don't show symptoms.

"Since early February, we have said that asymptomatic people can transmit COVID-19, but that we need more research to establish the extent of asymptomatic transmission," the WHO chief said at a virtual press conference from Geneva on Wednesday, Xinhua news agency reported.

"That research is ongoing, and we're seeing more and more research being done," he added.

Saying that the world has been achieving a lot in knowing the new virus, the WHO chief told reporters that "there's still a lot we don't

"WHO's advice will continue to evolve as new information becomes available," he said.

Tedros stressed that the most critical way to stop transmission is to find, isolate and test people with symptoms, and trace and quarantine their contacts.

"Many countries have succeeded in suppressing transmission and controlling the virus doing exactly this," Tedros said.

Meanwhile, Michael Ryan, executive director of WHO Health Emergencies Program, said Wednesday that the COVID-19 pandemic is still evolving.

"If we look at the numbers... this pandemic is still evolving. It is growing in many parts of the world," he said. "We have deep concerns that health systems of some countries are struggling, under a huge strain and require our support, our help and our solidarity."

He said "each and every country has a different combination of risks and opportunities, and it's really down to national authorities to carefully consider where they are in the pandemic."

In Europe, the risk issue now are about travels and the opening of the schools, around risk management, mass gathering, surveillance and contact tracing, said the WHO official.

In Southeast Asian countries, where to a great extent transmissions have been under control, governments are more concerned about the re-emergence of clusters, while in South America, the issue of PPE for health workers has not gone away, said Ryan.

As regards Africa, Ryan said the death rates have been very low in the past week, but the health system can be overwhelmed, as it would have to cope with other diseases such as malaria.

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Agencies
January 12,2020

Washington D.C., Jan 12: Disruption in one night's sleep can lead to getting Alzheimer's disease, a recent study has stated.

The interruption in the sound sleep for a single night aggravates the level of tau protein in any young male's body, thus gives rise to the chances of developing the disease.

According to CNN, the report was published on Wednesday in neurology, the medical journal of the American Academy of Neurology.

"Our study focuses on the fact that even in young, healthy individuals, missing one night of sleep increases the level of tau in blood suggesting that over time, such sleep deprivation could possibly have detrimental effects," says study author Dr Jonathan Cedernaes, a neurologist at Uppsala University in Sweden.

As defined by the Alzheimer's Association, tau is the name of a protein that helps in stabilizing the internal structure of the brain's nerve cells. An abnormal build-up of tau protein in the body can end up in causing interior cells to fall apart and eventually developing Alzheimer's.

"When you get more of that deep sleep and you get the REM sleep in the normal amounts, that improves clearance of abnormal proteins which we think is good," said Mayo Clinic neurologist Dr Donn Dexter, not the study author but a fellow of the American Academy of Neurology.

Earlier studies have also shown that getting deprived of sleep can allow higher tau development and accumulation. Thus that poor sleep can hasten the development of cognitive issues.

Researchers caution that the study is small and inconclusive, and acknowledged they were not able to determine what the increased levels might mean.

"This study raises more questions than answers," agreed Dexter on a concluding note, sharing, "What this is telling us is that we have to dig more deeply. Despite something we do for a third of our lives, we know so little about sleep and we're learning every day, particularly when it comes to sleep and dementia."

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Dr G K Sudhakar Reddy
August 4,2020

Being overweight or obese is now recognised as a serious cause of ill health and disability. There is a significant positive association between orthopaedic disorders and the level of obesity causing pain, deformity and difficulty in walking.

Excess body weight accumulation increases pressure on joints, particularly the hips, knees and ankles.

Here are a few type of  arthritis:

Osteoarthritis

It is a condition of damage/ wear and tear of the joint lining or cartilage. Obesity triggers this by loading excessive weight on the weight bearing joints like the knee and the hip. 

Knee Osteoarthritis

This is the most common arthritis especially in the Indian subcontinent.

While walking, an individual exerts 3 to 6 times pressure that of the body weight on the weight-bearing knee joint, which means in an obese with excess body weight, larger forces are exerted, which lead to higher risk of deterioration of cartilage.

In addition, there are excessive fat tissues that produce hormones and other factors that affect the joint cartilage metabolism and cause inflammation of the joints giving rise to joint pathology.  Leptin is one of the hormones causing knee osteoarthritis. 

Hip osteoarthritis

The force exerted across the hip is 3 times that of body weight. Hip osteoarthritis is caused by factors such as joint injury, increasing age and being overweight.    

Hand osteoarthritis

The observation that obese individual has a higher risk in having hand osteoarthritis has led to a hypothesis that the metabolic effect produced by fat tissue is the underlying factor. 

Osteoporosis

It is a progressive bone condition of decrease in bone mass and density (Bone Mineral Density or BMD) which can lead to an increased risk of fracture. Recent research suggests that obesity may accelerate bone loss. It is the amount of muscle mass which is seen in an active person, which accounts for bone strengthening effects and not due to the fat seen in a heavy person.

Low back pain

Low back pain from degenerative disc disease of the lumbar spine is one of the most disabling conditions in the community and overweight and obesity have the strongest association with seeking care for low back pain.

Managing Hip and Knee Osteoarthritis

Life style changes

If one is overweight, try to lose weight by doing more physical activity and eating a healthier diet. Regular exercise keeps you active and mobile and builds up muscle, thereby strengthening the joints and can improve symptoms. 

Pain Killers

Painkillers help with pain and stiffness for short term. They don’t affect the arthritis itself and won’t repair the damage to your joint. Creams and gels can be applied directly onto painful joints.

Nutritional Supplements

Glucosamine and chondroitin are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage. However, there is insufficient evidence to support the use of glucosamine in humans and one can expect only a mild-to-moderate reduction in pain

Joint injections

If pain from osteoarthritis is severe joint steroid injections are injected into the joints that can reduces swelling and pain. The injections can start working within a day or so and may improve pain for several weeks or months. 

Hyaluronic acid injections, which help to lubricate your knee joint also give short term relief. In early stages. Stem cell treatment or cartilage regeneration procedures are being tried in young people with small defects, however it is still experimental and lacks long term evidence.

Surgery

May be recommended if you have severe pain or mobility problems.

Arthroscopy

If one has frequent painful locking/stiffening episodes especially in the knee joint, an operation to wash out loose fragments of bone and other tissue as joint can be performed by a minimally invasive key hole procedure called Arthroscopy.

Arthrodesis

If hip or knee replacement is not suitable, especially in young people who do heavy manual work, one can consider an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

In young, active people in whom a knee joint replacement would fail due to excessive use one can consider an operation called an osteotomy. This involves adding or removing a small section of bone either above or below your knee joint.  This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually as you grow old

Joint replacement surgery

Joint replacement therapy is most commonly carried out to replace hip and knee joints. It involves replacing a damaged, worn or diseased joint with an artificial joint made of special plastics and metal.

For most people, a replacement hip or knee will last for at least 20 years, especially if it is cared for properly and not put under too much strain.

Dr G K Sudhakar Reddy is a Sr Consultant Orthopaedic Surgeon at Citizens Speciality Hospitals, Hyderabad

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