Selenium can be harmful for Skin cancer patients

Nutritional supplements are often tried to prevent cancer. But well- designed rigorously conducted clinical trials have NOT shown any benefit in prevention of many cancers.

Selenium was suggested as a preventative supplement for skin cancer.

A clinical trial compared Selenium against placebo in United States. The results were disappointing.

Selenium supplementation was found to be ineffective at preventing Skin cancers.

To make matters worse, Selenium was found to Harmful and increased the the risk of getting some skin cancers such as squamous cell carcinoma.

Selenium Supplementation and Secondary Prevention of Nonmelanoma Skin Cancer in a Randomized Trial. Anna J. Duffield-Lillico, Elizabeth H. Slate, Mary E. Reid, Bruce W. Turnbull, Patricia A. Wilkins, Gerald F. Combs, Jr., H. Kim Park, Earl G. Gross, Gloria F. Graham, M. Suzanne Stratton… Show moreJNCI: Journal of the National Cancer Institute, Volume 95, Issue 19, 1 October 2003, Pages 1477–1481, https://doi.org/10.1093/jnci/djg061

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Is the new vaccine against COVID-19 causing CoronaVirus safe and effective ?

Yes, the available short term data indicates the vaccine is safe and effective in vast majority of people.

The big unknown is the long term efficacy and side effects.

Normally medicine progresses slowly and carefully like a big train turning slowly on sharp uphill bend .

But due to pandemic emergency, the vaccines are being introduced to the the general public more more earlier than it would have done, well before availability of more mature data.

Long term, there are some uncertainties. For instance, there is a possibility of loss of efficacy if vaccine effect is not long lasting. But there is no evidence to suggest at present this would happen. As regards long term side effects, once more data is collected and more patients are followed up after vaccination, there will more mature data on side effects.

The available data suggests that very high groups who are a high risk of death from COVID , have good odds of benefitting from vaccine.

The trial data published so far, UK Medicine regulator conclusions , Pfizer data sheet and UK govt Guidelines has been positive so far.

It may be that low risk groups such as people in 20s, who have less chance of dying from COVID, may opt for more long term data before having the vaccination.

References:

NHS Coronavirus (COVID-19) vaccine

MHRA Regulatory approval of Pfizer / BioNTech vaccine for COVID-19

Information for UK recipients on Pfizer/BioNTech COVID-19 vaccine. Updated 16 December 2020.

Information for Healthcare Professionals on Pfizer/BioNTech COVID-19 vaccine. Updated 16 December 2020.

Public Health England. COVID-19 vaccination programme. Information for healthcare practitioners. Published December 2020. Version 2.1

The Green book chapter 14a COVID-19-SARS-Cov-2.

PHE. Confirmation of guidance to vaccination centres on managing allergic reactions following COVID-19 vaccination with the Pfizer/BioNTech vaccine. 9/12/2020.

British Society for Rheumatology. Guidance for COVID-19 vaccinations.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.


The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Does intensive follow benefit Bowel cancer patients?

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The old adage “prevention is better than cure” is mostly true with regards to cancer if you can do it.

If you can’t prevent it , at least catch it early, has been the prime motive behind screening tests for breast, cervical, bowel, lung and prostate cancers. (“early is better”). Cancers that are detected at an early stage can offer a better chance of curative treatment.

So one might logically expect that intensive monitoring and early diagnosis of a cancer relapse or a secondary cancer after initial treatment can be immensely helpful.

But the evidence for intensive hospital follow-up visits and investigations is weak for most cancers except for some cancers such as Testicular Cancers which are highly curable.

Intensive monitoring after bowel cancer treatment can detect treatable cancers. To confirm the benefit of early detection of relapse by intensive monitoring , a trial was conducted comparing intensive follow up versus routine follow up ( in France and Belgium).

Data presented at ESMO ( European Society of Medical Oncology) shows that the intensive follow with scans can detect cancer recurrences which can be treated by further surgery. But unfortunately the intensive follow up did NOT lead to longer life expectancy.

The results might be counterintuitive but after an average follow up more than six years, this trial demonstrates that intensive follow is NOT always best. Scans might be done for psychological reassurance but they could end up causing significant anxiety.

When there are resource constraints (e.g low economic countries) , one has to be careful about frequents routine scans for those without symptoms.

During COVID-19, even in rich countries such as UK where there might be huge waiting lists, one has to consider prioritising scans for those who need most.

References

1. ESMO Daily reporter: INTENSIVE FOLLOW-UP INCREASES FREQUENCY OF CURATIVE INTENT SECONDARY SURGERY IN COLORECTAL CANCER.

2. DRE is useless for follow up of prostate cancer patients. https://www.bmj.com/rapid-response/2011/11/03/dre-useless-follow-prostate-cancer-patients

3. Cancer patients follow up and a new role for GPs. https://www.bmj.com/rapid-response/2011/11/03/cancer-patients-follow-and-new-role-gps

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

A novel drug Osimertinib reduces risk of Brain cancer secondaries in lung cancer patients

Traditional intravenous Chemotherapy agents are often thought NOT to be highly effective in treating and preventing brain secondaries. This is because of the penal blood brain barrier.

Data presented at ESMO ( European Society of Medical Oncology) presidential symposium shows that the Osimertinib is highly active and significantly reduces risk of brain secondaries.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Immunotherapy not superior to Chemotherapy in 1st line treatment of bladder cancer

Immunotherapy has revolutionised the treatment of many advanced cancers such Skin cancer Melanoma and Kidney cancers.

Immunotherapy is a standard treatment for 2nd line treatment of bladder cancer.

Two recent trials presented at ESMO virtual meeting explored the use of immunotherapy in 1st line setting. (Pembrolizumab and Durvalumab).

Immunotherapy alone, or in combination with Chemotherapy was not superior even in patients selected by markers thought to favour immunotherapy alone.

For most bladder cancer patients immunotherapy remains a excellent 2nd line option or as a maintenance treatment option.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can you catch Coronavirus infection from Soft drink cans, Sandwich wrapper and Amazon Parcels?

Yes. Possible but chances are very small according to reports.

If someone sneezed or coughed near a parcel or food package and you touch it within a few hours, it is possible to get Coronavirus infection from parcels and packages.

But, in practice, most parcels and food packaging seem safe and no conclusive real world evidence has been published so far to indicate that packages spread infection widely.

In experimental conditions, Coronavirus has been shown to survive for upto 72 hours. The virus is “more stable on plastic and stainless steel than on copper and cardboard”.

In laboratory conditions “On copper, no viable SARS-CoV-2 virus was measured after 4 hours . On cardboard, no viable SARS-CoV-2 virus was measured after 24 hours”.

In the artificial conditions of the lab “The longest viability of viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 virus was approximately 5.6 hours on stainless steel and 6.8 hours on plastic”.

Solution: If you are worried , and if possible, you can try leaving parcels for 24hrs before touching them with bare hands. Alternatively, try wearing disposable gloves to remove packaging.

References

1.NEJM. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. April 16, 2020. N Engl J Med 2020; 382:1564-1567. DOI: 10.1056/NEJMc2004973

2. BBC. Coronavirus: What are the risks of catching it from food packaging?

3. CDC. How It Spreads.

Does Eating Eggs lead to Heart problems?

No, Eating Eggs in moderation is not associated with increased Heart problems.

Heart diseases are one of major killers in Men and Women. In the past, Cholesterol was exclusively blamed for most of the Heart problems. Nowadays, such a simplistic view has been abandoned. We now know that Heart diseases are due to a complex set of poor diet and life style.

Previously Eggs which have lot of dietary cholesterol have been subject to lot of bad press.

A recent pooled analysis of good quality data shows that ” moderate egg consumption (up to one egg per day) is not associated with cardiovascular disease risk overall, and is associated with potentially lower cardiovascular disease risk in Asian populations.”

So like everything else with regards to diet , moderation is the way to go !

Reference

Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m513 (Published 04 March 2020)

Cite this as: BMJ 2020;368:m513

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Is Chloroquine useful in treatment of Corona Virus?

Chloroquine and the related drug Hydroxy-Chloroquine are drugs commonly used to prevent and treat Malaria infections; and treat some Joint conditions.

During the initial stages of COVID-19 pandemic, there were some reports of Chloroquine being useful in treating Corona Virus.

A Chinese trial published in British Medical Journal BMJ now reports that ” Administration of hydroxychloroquine did not result in …. any meaningful antiviral benefits… compared to standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19

Chloroquine was not only useless but it had significant side effects in a minority. So Chloroquine or Hydroxy-Chloroquine should not be used routinely outside a clinical trial setting.

References

1. Hydroxychloroquine (HCQ). Wiki. https://en.m.wikipedia.org/wiki/Hydroxychloroquine

2. BMJ. Chloroquine and hydroxychloroquine in covid-19. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1432 (Published 08 April 2020)

3. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1849 (Published 14 May 2020)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Acupuncture for Migraine

Can Acupuncture help migraines?

Yes, says a Chinese trial published in British Medical Journal .

Many complementary and Alternative therapies have very thin evidence base ( if all present ).

The researchers are to be congratulated for doing a randomised trial and publishing results in a peer reviewed medical journal

References

Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m697 (Published 25 March 2020)

Cite this as: BMJ 2020;368:m697

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Exciting new immunotherapy treatment !

Test tube lab

The holy grail of cancer treatment is design a drug that is highly lethal to cancerous tissue but completely spares the normal tissues.

Scientists at Cardiff University have discovered immune cells which could provide such a clever treatment.

It is still early days. The principle has been proven in lab. But to be a useful treatment that can be used in cancer patients, it is still far off.

This particular novel form of immunotherapy using T cells is still in early stages and so many hurdles have to be overcome before this discovery could be employed in cancer treatment.

Nevertheless, it has certainly excited many researchers in the field of cancer and the paper has been published by a premier scientific journal.

 

References:

Original scientific paper. Genome-wide CRISPR–Cas9 screening reveals ubiquitous T cell cancer targeting via the monomorphic MHC class I-related protein MR1

BBC news. Immune discovery ‘may treat all cancer’. By James Gallagher. Health and science correspondent

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Melanoma Skin cancers: significant improvement in life expectancy with immunotherapy

Advanced melanoma skin cancers used to carry a dismal prognosis.

Data presented at Barcelona European Cancer Congress ( ESMO) shows the prognosis has improved remarkably in the recent years.

Fifty percent of patients are now alive for at-least five years. It is quite a remarkable achievement for immunotherapy.

References

1. ESMO press release. One in Two Patients with Metastatic Melanoma Alive after Five Years with Combination Immunotherapy [ESMO 2019 Press Release].

2.BBC News. Skin cancer: Half of people surviving advanced melanoma. By James Gallagher. Health and science correspondent, BBC News

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.