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Brain tumour: Management options and outcome

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Brain tumour: Management options and outcome

Brain tumours are abnormal growth of brain cells and can be benign or malignant (cancerous). In a broad sense, brain tumours can be primary or metastatic (from cancer of other parts of the body). Such tumours clinically manifest with various symptoms depending on their location, size, and histological variety. Common presentations of brain tumours are headaches, vomiting, and seizures, or epilepsy. Some may have focal neurological deficits like weakness of limbs, memory impairment, speech problems, restricted vision, gait disturbances etc.
The incidence of brain tumours is increasing and is 5 to 10 per 100,000 in the Indian population. They represent a substantial cause of morbidity and mortality and an overall decrease in productivity. The gradual increase in the incidence of brain tumours in young populations has also led to a significant financial burden on families. Early diagnosis and management has a better outcome in patients with brain tumours.

What are the causes of brain tumours?
The risk factors associated with brain tumours are ionising radiation, environmental factors, and mutations of genes controlling cell growth. Various hereditary conditions like neurofibromatosis and tuberous sclerosis are also associated with higher incidences of brain tumours. 

What are the types of brain tumours?
The common primary brain tumours are gliomas, meningiomas, pituitary tumours and nerve sheath tumors. Gliomas are the most common intraparenchymal brain tumours and can be of low grade or highly malignant high grade. Secondary brain tumours or metastatic brain tumours originate from cancer in other parts of the body and spread to the brain through the blood or lymphatics. Cancers from lungs, breast, kidney, prostate, and melanoma commonly spread to the brain. The incidence of metastatic brain tumours is higher than primary tumors.

How are brain tumours diagnosed?
Brain tumours can be diagnosed on the basis of clinical symptoms. Some specific symptoms like early morning headache that subsides with vomiting, repeated seizures involving a particular area of the body (like hand, face, leg etc.), visual field restriction (narrowing of the visual field, being unable to see one half of the visual field) are characteristics of brain tumors. However, the diagnosis is confirmed with radiological evaluation. A CT scan of the head can grossly show the brain tumor. Additionally, various sequences of MRI provide details about the nature of tumour, like low grade or high grade. However, the exact nature of cellular origin and biological characteristics can be detailed by histopathological study of tumour tissue obtained from biopsy or surgery. This is also important in grading the tumour into the low grade or high grade variety.

What are the treatment options available for brain tumours?
There are several treatment options for brain tumors, including surgery, radiotherapy, chemotherapy, and gamma knife radiosurgery. Biopsy of the tumour may be considered for smaller intraparenchymal brain tumors. The MRI guided streotactic brain tumour biopsy provides accurate localisation of the brain tumour as well as tissue diagnosis or histopathological characterization of the brain tumour. Then, depending on the grade of tumour further therapy like radiation or chemotherapy can be planned for such patients. However, complete surgical excision is the best treatment for brain tumours and has a better long-term onco-functional outcome.

What are the risks involved in brain tumour surgery and how can they be reduced?
As the brain is the controller of entire body function, any additional injury to the nearby brain area during tumour surgery may result in functional impairment. Therefore, the brain tumour has to be resected out with minimal handling of the adjacent brain tissue. Various functional imaging techniques like functional MRI and diffusion tensor imaging are used to detect the functional brain areas around brain tumors. Again, such areas can be stimulated and preserved with the use of direct electrical stimulation in patients operated in awake conditions. Further use of intraoperative ultrasound also reduces the risk of injury to normal brain areas. Use of these advanced modalities allows better tumour removal even if the tumour is located in eloquent areas like insular glioma, brain stem glioma. A variety of brain tumour surgeries like glioma, vestibular schwannoma are also being used to minimise functional deficits after surgery.
Minimal invasive surgery for brain tumours like endonasal endoscopic procedures are now the standard of care for operating pituitary tumors.
Even large brain tumours located in the pituitary region can be operated safely through the nose using an endoscope.
What is gammaknife radiosurgery and which brain tumours are managed with this?
Gammaknife radiosurgery is a form of radiation therapy where radiation is precisely focused on the brain tumours with minimal effect on surrounding brain areas. Commonly, small, benign brain tumours like meningioma, vestibular schwannoma, cavernous hemangioma, cavernoma, etc. are treated with gamma knife radiosurgery. This has the ability to safeguard important functional brain areas like the cochlea (hearing apparatus), optic nerve (visual apparatus), and brain stem while giving an adequate dose to the brain tumour targeted for therapy. Apart from this gammaknife radiosurgery provides excellent results in patients with brain arteriovenous malformation.

What is the prognosis of a brain tumour?
The outcome of a brain tumour depends on the type (low grade vs. high grade), location, extent of tumour removal, and the patient’s clinical condition. Good tumour removal always has a better outcome in patients with low grade tumors. Therefore, maximal tumour removal is always attempted in these cases. However, high grade tumours like glioblastoma have a poor prognosis even after complete tumour removal and post-operative radiotherapy and chemotherapy. Apart from this, certain genetic mutations like TP53, IDH1/2, ATRX, 1p19q, etc also affect the prognosis.

Who should be screened for
brain tumours?
Patients who have already been diagnosed with cancer of the lungs, breast, kidney, or prostate and develop symptoms such as headache, vomiting, or seizures should be evaluated for a brain tumor. Any metastatic lesion can be detected using a CT scan or an MRI of the brain. People with a family history of cancer or previously diagnosed with hereditary syndromes like neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, and multiple endocrine neoplasia are prone to developing brain tumours and should be screened regularly.

Dr Sushant Kumar Sahoo is an Associate professor at Department of Neurosurgery and Gammaknife, Radiosurgery at PGIMER, Chandigarh.

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Medically Speaking

The Power of Seva

Dr Chavi Bhargava Sharma

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The Power of Seva

If I were to ask you as to what differentiates the human species from other species, your response would probably be that humans are bipedal, have the power of language, are self-aware, can think, but what really differentiates us is our capacity to do “seva”, our ability to help others. Only the human species has this capacity for helping all life forms, which we call altruism, prosocial and philanthropic behaviour. But the essence is captured in the word ‘seva.’
Seva is a Sanskrit word meaning selfless service and is perhaps considered the most important part of our existence. It asks us to serve others with no expectation of outcome. A parallel western concept is volunteerism/help/service/community/social service, philanthropy, and the more contemporary and chic Corporate Social Responsibility and Institutional Social Responsibility.
Seva is a motivational state that a person possesses with the goal of increasing the welfare of another living being. While Seva, on the surface, seems to benefit others, it is actually the individuals engaged in Seva who also benefit. Seva is positively correlated with happiness, health, and well-being. People who did Seva showed greater satisfaction in life and exhibited reduced rates of depression and anxiety. So when you feel depressed, lonely, or anxious, go out and do seva. It could be working with animals, humans, the environment, etc. It is therapeutic and all-consuming and leaves no room for negativity.
While many of us feel drawn to helping others, our ego tends to drop in and voice our own thoughts. We use it to promote ourselves, our brands, and flaunt our service, which makes it counterproductive. Ego can also judge how we serve others. It may tell us that some types of service are more noble than others. “Oh, you help your neighbour once a week with her groceries? Well, I run events that serve 500 people.” “Oh, you help animals. Why don’t you help old people or children? “ This is not seva but the ego at work, because the aim of seva is to silence the ego, dissolve the ego, as all mental diseases emanate from the ego and its fears.
When we serve with the essence of seva in mind, we begin to see the myriad ways the ego, the source of all our troubles, is standing in front of the heart. When we transition from the head to the heart, then Seva becomes a practice of purification, a spiritual act. It is also in listening to the heart that we begin to understand that our innermost nature is a giving one. While the ego mind may tell us we need to focus on ourselves and even when we serve, it is when we shift into the spirit of seva that we realise we are naturally kind. In other words, we are naturally moved to serve others. It is when we do seva that we realise that all life is connected and working for others is the only path to mental fitness, wellness, and wellbeing and the royal road to spiritual growth.
The question you need to ask yourself for your happiness is, “Did you do Seva today?”

Dr Chavi Sharma Bhargava is the founder and CEO of Indic Center for Psychological Wellness and Holistic Health and Conversationists-Talking Cures. 

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Dr Vishali Gupta becomes first female Asian President of global Uveitis body

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Dr Vishali Gupta becomes first female Asian President of global Uveitis body

In a rare feat, a female ophthalmologist from Asia has become President of the International Uveitis Society Group and has been able to mark PGIMER at the global level. Uveitis is a field of medical science in which rare specialists are found and trained so far. The Daily Guardian had a one-on-one conversation with Dr Vishali Gupta on this and talked about the responsibilities she would have as president of this prestigious society.
 
What is this society all about? What is Uveitis?
The International Uveitis Study Group was formed in 1978 by a small number of clinicians who shared a common interest in Uveitis. Over the next almost 40 years, the group has increased in size to over 180 Uveitis specialists from all over the world.

What is uveitis?
Uveitis is the name given to inflammation inside the eye that, in some patients, can lead to blindness. It can affect one or both eyes, and the inflammation involves the uveal tract (iris, ciliary body, and choroid), although inflammation of adjacent tissues, such as vitreous humour, retina, and optic nerve also occurs. It could be due to an autoimmune disease and sees no age.

How long has the PGIMER been treating Uveitis, and how many experts does the department have?
PGIMER, under the stewardship of Dr Amod Gupta, has been working in the field of Uveitis since the 1990s. Then Dr Vishali Gupta, along with five experts, inducted Tuberculosis in Uveitis for the first time in the world. PGIMER has a special clinic for Uveitis patients, and these patients’ treatments are long, sometimes lifelong. Since PGIMER has Rheumatology, Microbiology, Research Scientists, and Pediatricians all under one roof, it is easy for the patients to get the best treatment. In the other sectors, it is not that easy.

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Foods that can help you REDUCE headaches, migraine

Dr Anish Desai

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Foods that can help you REDUCE headaches, migraine

Following a healthy diet can increase longevity, protect against disease, and improve your overall quality of life. Several nutrients in food promote health and protect your body from disease. The “Food as Medicine” concept generally refers to managing food and diet in an individual’s routine, with the aim of preventing, reducing symptoms of, or reversing a disease process. Research has shown that dietary habits can influence risk factors for disease. While certain foods can trigger and aggravate health conditions, others may offer significant medicinal and therapeutic advantages.
Headaches are a common occurrence that is encountered routinely by individuals. A study conducted by Biman K Ray in 2017 revealed that the one-year prevalence of migraine in an Indian population was found to be 14.12%. Headaches can be triggered by several small incidents that might not be considered significant. Sleepless nights, skipping breakfast, work pressure or stress, and excessive blue-screen exposure are all examples of irregular routines that can cause headaches. Migraine is a disabling primary headache disorder experienced predominantly by women and triggered by hormonal, emotional, physical, dietary, environmental, and medicinal factors.
In individuals, migraine triggers can include specific foods or types of foods. Eating a healthy diet can help prevent migraines and headaches. Alternatively, certain foods can decrease the frequency of migraine headaches or lessen the intensity of their symptoms. Though no definitive ‘migraine diet’ has been described,’ individuals may be able to reduce their migraines by monitoring the food that they eat.

Foods to avoid
Nuts and certain seeds: Tyramine, present in nuts and certain seeds, can induce headaches and migraines.
Cheese: Aged cheese consists of high levels of tyramine, which aggravates migraines and headaches.
Caffeine: According to clinical studies, drinking more than one to two cups of coffee per day can cause migraines in 14% of patients. 
Chocolate: Chocolate is the most common migraine food trigger, and it has been epidemiologically linked to migraine attacks, so doctors typically advise migraine patients to avoid it.
Tomato-based products: They contain a high amount of histamine or tyramine that can aggravate migraines.
Avoid processed (packaged) foods: Nitrates and nitrites present in processed foods cause swelling of the blood vessels and can trigger migraines.

Foods to consume
Dark green leafy vegetables: Study published in BMJ Case report revealed that inclusion of leafy vegetables in meals can play pivotal role in relieving migraine or chronic headache .
Turmeric: Curcumin present in turmeric helps in relieving migraine frequency and duration.
Coriander: Consumption of coriander leads to a greater reduction in the duration, severity, and frequency of migraines.
Citron: It has reported several benefits in clinical trials however it also helps in reducing migraine intensity and duration.
Clinical trials of several herbal medicines indicate that various foods, through their multifactorial physiological influences, present potential options to improve migraine treatment.
The author is MD, Clinical Pharmacologist and Nutraceutical Physician, Founder and CEO IntelliMed Healthcare Suctions.

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Active Covid cases have decreased, with 3,947 cases reported in the last 24 hours

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COVID-19

According to Union Health Ministry data updated on Friday, India’s COVID-19 case tally increased by 3,947 in a day to 4,45,87,307, while active cases decreased to 39,583.

The death toll has risen to 5,28,629, with 18 more deaths, including nine fatalities reconciled by Kerala, according to data updated at 8 a.m.

According to the health ministry, active cases account for 0.09 per cent of total infections, while the national COVID-19 recovery rate has increased to 98.73 per cent.

The daily positivity rate was 1.23 per cent, with a weekly positivity rate of 1.44 per cent.

The number of active Covid cases fell by 1,167 in a single day, while the number of people who recovered from the disease rose to 4,40,19,095. The case fatality rate was calculated to be 1.19 per cent.

According to the ministry, the Nationwide Vaccination Drive has resulted in the administration of 218.52 crore total vaccine doses (94.84 crores second dose and 21.19 crore precaution dose).

Two deaths were reported in Maharashtra and West Bengal, and one each in Uttar Pradesh, Punjab, Karnataka, Haryana, and Chhattisgarh. Kerala has made amends for nine deaths.

On August 7, 2020, India’s COVID-19 case tally surpassed 20 lakh, followed by 30 lakh on August 23, 40 lakh on September 5, and 50 lakh on September 16. It surpassed 60 lakh on September 28, 70 lakh on October 11, 80 lakh on October 29, 90 lakh on November 20, and one crore on December 19.

Last year, the country passed the two crore mark on May 4 and the three crore mark on June 23. On January 25, this year, it surpassed the four-crore mark.

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Medically Speaking

PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40

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PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40

An individual becomes more concerned about their health as they reach a certain age. As the most vital organ of the body, the heart requires extreme care as its chances of developing cardiac diseases increase with age.
Among older people, heart disease is the leading cause of morbidity. To reduce the risk of CVD in middle age, it is recommended to maintain or increase physical activity. Dr AnbuPandian, Medical Advisor, Agatsa, shared some tips to keep the heart healthy at 40 with us.

Stay Active
The most effective way to prevent heart disease at 40 is to adopt a healthy lifestyle. If you work nine hours in an office job, take short breaks every two hours. Taking the stairs instead of the lift, walking short distances instead of using a vehicle or public transportation. Exercise, meditate, swim, play basketball, dance, and do yoga—whatever you love.

Exercise Regularly
Physical exercise has been shown to have a positive effect on heart health in comparison to sedentary lifestyles in various studies. A great quality of life is dependent on a healthy heart. Maintaining a regular exercise routine will keep the heart healthy for years to come.

Regular Heart Health Check-ups
A heart health check-up is essential at every stage of life, but becomes especially crucial after age 40. There are several factors that determine how often a person should get a check-up, including smoking, alcohol consumption, heart disease in the family, being overweight, and diabetes. Blood sugar and cholesterol levels should also be monitored closely. Heart diseases can be better treated if they are detected early. Once a person crosses the age of 40, a yearly checkup is mandatory. The physician may recommend more frequent check-ups if heart disease is detected.
As age increases, metabolism tends to decrease by 5 % every decade after 40. Hormonal imbalance and bone density are two other significant changes that the body registers while getting old. Increase the intake of fruits rich in Vitamin C. All citrus fruits, for that matter, have a bonus heart-healthy benefit. The best diet for preventing cardiac disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils. Individuals who follow their dietary pattern have a 31% lower risk of heart disease than those who consume junk food.

Remote Monitoring Machines
Remote monitoring machines have been around for years but have gained significant prominence recently, thus resulting in high demand. Such devices are used on a daily basis to monitor diseases such as heart attacks, hypertension, and diabetes. These devices are very portable, user-friendly and capture patients’ health parameters via cables and sensors. These devices are cost-effective for patients because they reduce medical care costs and provide more timely intervention for chronic conditions. No one can slow down the ageing process. However, with proper care, one can be more fit, look younger, and lead a more energetic and active life. Life doesn’t end, but begins afresh again at 40!
The author is a Medical Advisor at Agatsa.

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Why heart attacks are on the rise among women

Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.

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Why heart attacks are on the rise among women

Heart diseases are no longer a “men’s problem” and women too are equally prone to them. According to a recent report published by the National Family Health Survey, it was found that the overall prevalence of undiagnosed hypertension in women of the age group 15–49 years is 18.69% in India, which busts the myths that heat conditions are most prevalent among men.
Several other international studies have also indicated that heart ailments are now a leading cause of death among women, resulting in ten times more fatalities than breast cancer. Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Why are heart diseases going undetected in women? While ensuring the well-being of their loved ones, women in India tend to ignore their own needs and often neglect their health. For instance, if a woman has mild chest pain, she would rather ignore the symptoms and focus on managing the work/household chores rather than visiting a doctor. The patriarchal setup of our society also expects women to keep the well-being of others at the forefront rather than taking care of themselves, which results in late diagnosis and is one of the primary causes of increasing heart ailments among women in the country.
As the symptoms of a heart attack are different in both men and women, many women often don’t know if they have already suffered one or two heart attacks in the past until eventually, they visit a doctor. While in men, a heart attack usually results in extreme and sudden chest pain and breaking out in cold sweats, whereas in women, the symptoms are usually mild and heart attacks can be frequent and smaller. The symptoms in women can range from jaw pain to fatigue to pain in the neck and back to sweating or just heartburn, indicating the need for them to undergo regular health check-ups and take proactive measures to ensure overall well-being.
Which age group is most susceptible to heart attacks and what are the major concerns?
Women of the age group 45–55 years are at a high risk of experiencing a heart attack due to low levels of estrogen post menopause, work and family-related stress, loneliness, and lack of physical activity. More women in this age group may go undiagnosed and have atypical symptoms compared to men.
The second most affected age group is 60 years of age, where the biological deterioration makes both men and women more susceptible to heart attacks. High cholesterol, blood pressure, obesity, smoking, sedentary lifestyle, and diabetes are also some of the main concerns that make women more prone to cardiovascular diseases.
How can women take care of themselves and keep heart attacks at bay?
There are several steps that women can take to prevent heart ailments, such as:

  1. Educate yourself and increase awareness about the risk factors that can lead to blockages.
  2. Avoid smoking or the use of tobacco.
  3. Engage in physical activities like yoga, dancing, running, and walking for 30–45 minutes every day to maintain heart health and overcome obesity.
  4. Avoid junk food, aerated drinks and adopt a balanced diet. Healthy heart diets that include complex carbohydrates, legumes, fruits, vegetables, and less sugar, salt, and fat can have a positive impact on heart health.
    Lastly, it is important to note that gender has nothing to do with heart attacks, and the condition affects both men and women equally. However, adopting a healthy lifestyle and undergoing regular health checkups can help you get the gift of good health.

The author is a Senior Consultant at Interventional
Cardiology, Aster CMI
Hospital, Bangalore.

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