Lung cancer: risk factors, management, and prognosis

Lung cancer or lung tumor the most common cause of cancer death in men and second most common in women after breast cancer. Highest rates in North America, Europe, and East Asia, with one third of new cases in China, lower rates in Africa and South Asia. Worldwide in 2012 lung cancer resulted in 1.6 million deaths. Risk factors include smoking, exposure to radon gas, asbestos, second-hand smoke, air pollution, and geneticfactors. Pathogenesis is similar to other cancers, by activation of oncogenes or inactivation of tumor suppressor genes. Two main types of lung cancer are small-cell lung carcinoma(SCLC),and non-small-cell lung carcinoma(NSCLC) Clinical manifestation include coughing, coughing blood, weight loss, weakness, fever or clubbing of the fingernails, hypercalcemia, myasthenia syndrome (muscle weakness), and metastases. Metastatic disease includes weight loss, bone pain and neurological symptoms. Diagnosis mainly by chest radiographs and computed tomography (CT) scans. Lung cancers are classified according to histological type, staging uses TNM (tumor, lymph node and metastases) system. Management depends on cancer specific type, by surgery, radiotherapy and chemotherapy. In the U.S 16.8% survive for at least five years, in England overall five year survival less than 10%.Prevention, cessation of smoking, screening for lung cancer for those long smoking history and between 55 and 80 years. Long term intake of vitamin A,vitamin vitamin D, or vitamin E does not reduce risk of lung cancer. Higher intake of vegetables and fruit tend to lower risk. There is no clear association between diet and lung cancer

Liver cancer: contributory factors, diagnosis and treatment

Liver cancer have high mortality secondary to hepatitis B,hepatitis C and secondary to alcohol.Hepatocellular carcinoma (HCC),most common form of liver cancer with highest rates in China and in Sub-Saharan Africa. Approximately 75% of all primary liver cancer is HCC (also named hepatoma). Cholangiocarcinoma can form within liver as the bile duct.Liver fluke infection increases the risk of cholangiocarcinoma in Thailand.Tumor of blood vessels-angiosarcoma.Cancers produced from muscles in the liver are leiomyosarcoma.Many cancers in the liver are due to metastasis. Contributory factors of liver cancer includes: viral infection either with hepatitis C (HCV) or hepatitis B (HBV). Viruses cause HCC because massive inflammation, fibrosis and eventual cirrhosis within the liver. Aflatoxin exposure can lead to the development of HCC. High grade dysplastic nodules are precancerous lesions of the liver. Beckwith-Weidemann syndrome is associated with hepatoblastoma in children. Liver cancer is associated with abdominal mass, abdominal pain, emesis, anemia, back pain, jaundice, itching, weight loss and fever. Diagnosis mainly by ultrasound, CT, MRI, and magnetic resonance cholangiopancreatography (MRCP). Tests for tumor markers are helpful. Treatment by surgery, antiviral drugs and liver transplant. Prevention by reducing exposure to risk factor for liver cancer, vaccination against hepatitis B virus, reducing alcohol abuse,prevention of carcinogenesis and treatment to prevent recurrence of liver cancer, by the chemotherapy drugs and antiviral drugs.With the advances in diagnosis and treatment the prognosis in liver cancer remains poor

Primary Hepatocellular carcinoma: management and prognosis

Hepatocellular carcinoma (HCC) causes high mortality worldwide with 50 per cent of them in China. HCC cases are as a result of a viral hepatitis (hepatitis B or hepatitis C), metabolic toxins such as alcohol or aflatoxin, conditions like hemochromatosis and alpha 1-antitrypsin deficiency or non-alcoholic steatohepatitis (NASH). The high prevalence rate of hepatitis C virus (HCV occurs in African and Asian countries. The markers of hepatitis C infection (positive-anti HCV) are found in 80% - 90% patients in Japan, 70% in Egypt, 40- 50% in Pakistan and 35-40% in Saudi Arabia. China is classified as high endemic area with 8% - 20 % prevalence of hepatitis B virus (HBV). Other Asian countries are characterized as moderate to high prevalence rate of HBV in their population. The prevalence of HBV infection in children has declined in countries since the beginning of the vaccination. Chronic infections of hepatitis B and/or C can aid the development of HCC by repeatedly causing body’s immune system to attack the liver cells, some of which are infected by the virus. Aflatoxin is a carcinogen and aids carcinogenesis of HCC in the liver. Ultrasound and imaging modalities are used to aid in the diagnosis. Therapies include surgical resection, interventional radiology, and liver transplant. Prognosis for metastatic or unresectable HCC has improved due to sorafenib (Nexavar ®). Prevention of hepatitis B or C infection, childhood vaccination, reduce alcohol intake and avoiding the risk factors is the key to prevent HCC

Breast cancer: detection markers, prognosis, and prevention

Breast cancer is the common invasive cancer with high mortality worldwide. High incidence of breast cancer in South and central America, Southren, Northren, Westren Europe, Ocenia and North America. Lowest breast cancer incidence in Africa and Asia. Risk factors includes: female sex old age, lifestyle, oralcontraceptive, hormone replacement therapy, mutations in the breast cancer susceptibility genes BRCA1orBRCA2.alcohol intake, hereditary factors, and exposure to chemicals. Breast cancer occurs because of an interaction between external factor and genetically susceptible host. Frequent symptoms of breast cancer is typically a lump and lumps found in the lymph node in the armpits. Diagnosis by physical examination of the breast and mammography. Further tests include histopathological examination, breast cells grading by TNM systeme.g., Zero stage a precancerous or marker condition, stage 1- 3 within the breast and regional nodes, and stage four is metastatic stage. Management of breast cancer depends on the stage of the cancer and age of the patient. Usually treated with surgery, chemotherapy or radiation therapy or both. A multidisciplinary approach is preferable. Metastatic cancer has less favorable prognosis. Prognosis is usually the probability of progression-free survival(PFS) or disease free survival(DFS).Prevention include change in life style, maintaining healthy weight, less alcohol consumption, and intake of marine omega-3 and soy-based foods Prophylactic mastectomy(removal of both breasts) helps in people with BRCA1 and BRCA2 mutations. Early detection of breast cancer has better prognosis

Hemophilia a genetic disorder: diagnosis, treatment and prognosis

Hemophilia a genetic disorder with patient’s inability to stop bleeding. There are two main types of hemophilia, hemophiliaA due to not enough clotting factor VIII and hemophilia B due to not enough factor IX,and acquired hemophilia A(AHA) caused by autoantibodies against clotting factor VIII(FVIII).AHA is associated with malignancy,autoimmune disorders, and pregnancy. Factor IX deficiency can cause interference of the coagulation cascade. People with more severe hemophilia usually suffer more severe and more bleeds than people with mild hemophilia. Complications of hemophilia include deep internal bleeding, joint damage, transfusion induced infection, adverse reactions to clotting factor treatment, and intracranial hemorrhage. Diagnosis of hemophilia can be confirmed by, coagulation screening test, bleeding scores and coagulation factor assay. Gold standard of treatment is rapid treatment of bleeding episodes decreases damage to the body.Prophylactic treatment although high costs, is more effective than on demand treatment. People with severe hemophilia without adequate treatment have generally shortened lifespans. Gene therapy is not currently an accepted treatment for hemophilia

Gut-microbiota link in Parkinson’s disease: current perspectives

Parkinson’s disease(PD) is a metacentric neurodegenerative disorder results with accumulation and aggregation of alpha-synculein(α-Syn) (or alpha-synculeinopathy) in the substantia nigra in the central nervous system(CNS).Contributory factors include pesticide exposure, head injury and agriculture background. PD has been considered to be a non-genetic disorder, however around 15% individuals with PD have firstdegree relative who has the disease Mutations in genes including SNCA,LRRK2 and gluococerebrosidase (GBA) found to be risk factor for sporadic PD. Brain cells could be lost due to an abnormal accumulation of the protein alpha-synculein.This insoluble protein accumulates inside neurons forming inclusions called Lewy bodies. Other cell death mechanisms include proteasomal and lysosomal system dysfunction, but the mechanisms are not fully understood. Brain –gut axis(GBA) refers to central nervous system(CNS) control of the enteric nervous system(ENS) through vagus nerve intervention. PD is characterized by alphasynculeinopathy affecting all levels of the brain-gut axis.Both clinical and neuropathological evidences indicate the neurodegenerative changes in PD are accompanied by gastrointestinal symptoms that may precede or follow the central nervous systemimpairment. Frequent symptoms in PD include tremor, rigidity, slowness of movement and difficulty with walking. Treatment with L-DOPA(levodopa),with dopamine agonist, medications become less effective and produce complications. Research studies recommend new therapeutic approach in PD based on modification of the gut microbiota with probiotics, prebiotics, or even fecal microbiota transplantation

Competing biosecurity and risk rationalities in the Chittagong poultry commodity chain, Bangladesh

This paper anthropologically explores how key actors in the Chittagong live bird trading network perceive biosecurity and risk in relation to avian influenza between production sites, market maker scenes and outlets. They pay attention to the past and the present, rather than the future, downplaying the need for strict risk management, as outbreaks have not been reported frequently for a number of years. This is analysed as ‘temporalities of risk perception regarding biosecurity’, through Black Swan theory, the idea that unexpected events with major effects are often inappropriately rationalized (Taleb in The Black Swan. The impact of the highly improbable, Random House, New York, 2007). This incorporates a sociocultural perspective on risk, emphasizing the contexts in which risk is understood, lived, embodied and experienced. Their risk calculation is explained in terms of social consent, practical intelligibility and convergence of constraints and motivation. The pragmatic and practical orientation towards risk stands in contrast to how risk is calculated in the avian influenza preparedness paradigm. It is argued that disease risk on the ground has become a normalized part of everyday business, as implied in Black Swan theory. Risk which is calculated retrospectively is unlikely to encourage investment in biosecurity and, thereby, points to the danger of unpredictable outlier events

Analysis study on healthcare provider cost for diabetic foot treatment at orthopaedic ward, Universiti Kebangsaan Malaysia Medical Centre in year 2006

Introduction : Diabetes mellitus is recognized as a major public health problem worldwide. The burden of diabetes to society are morbidity, mortality and extensive usage of health care services. Methodology : This study aimed to determine the provider’s cost in treating diabetic foot patient per day in orthopaedic ward, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in year 2006. Result : A total of 54 patients fulfilled the inclusion and exclusion criteria, only 29 were eligible for analysis. The cost of health care providers derived from cost calculation on capital and recurrent costs. Results showed that the average cost for treating diabetic foot patient per day is RM 634.57. Recurrent costs contributed 75.3% of the total diabetic foot treatment and Intensive Care Unit costs was the biggest percentage (40.5%). Discussion : The results were comparable with findings by Case-Mix Unit of UKMMC. Treatment cost of diabetic foot is substantial and therefore avoidance of this complication must be emphasized to all diabetic patients