Tag: Dr Sundar’s blog

Face Masks: Should Public wear face masks because of Corona Virus pandemic ?

Should Public wear face masks because of Corona Virus pandemic ?

Yes.

In some of the Asian Countries there has been universal acceptance of face masks even before Corona Virus pandemic. Hence, it is not surprising that there is wide spread use of face masks during this pandemic .

In USA, after initial hesitation, CDC now recommends use of cloth face masks by public.

In Germany, many states have made face masks compulsory.

In UK, there has been no official recommendation about widespread use of face masks.

With so many unknowns, it is prudent to follow the advice published in British Medical Journal : WEAR A MASK !!

References

1. USA CDC. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

2 Germany: BBC news. Coronavirus: Germany’s states make face masks compulsory. 22 April 2020. https://www.bbc.co.uk/news/world-europe-52382196

3. TIME Magazine. https://time.com/5815251/should-you-wear-a-mask-coronavirus/

4. BMJ paper. Analysis. Face masks for the public during the covid-19 crisis. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1435 (Published 09 April 2020). Cite this as: BMJ 2020;369:m1435

5. BMJ editorial. Editorial. Covid-19: should the public wear face masks?. Editorials. Covid-19: should the public wear face masks? BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1442 (Published 09 April 2020). Cite this as: BMJ 2020;369:m1442

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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 expressed are not substitute for professional advice.

Does air pollution in cities make your jogging and walking less beneficial ?

Yes, air pollution is now being recognised as an important cause of death in major cities and towns.

So avoid major roads and very busy streets.

Any benefit you might accrue from exercise can be wiped out by heavy air pollution if you are jogging on a heavily congested road.

References

1. Telegraph: Pollution wipes out the benefits of exercise, study suggests

2. BMJ . Air pollution. Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6258 (Published 27 November 2019)

3. Telegraph. Does exercising in pollution do you more harm than good?

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.

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.

Is it worthwhile to be on constant vigilance for any symptoms which might indicate cancer has come back ?

Unfortunately no.

A Cancer charity advices to watch out for symptoms.

Constant Vigilance for cancer recurrence has its own downsides.

After successful cancer treatment, being on look out for symptoms constantly wrecks your quality of life for minimal benefit in most cases.

Many trials of intensive screening shown no benefit for early detection of secondary cancer. ( note- this is different from the ongoing debate about benefits of primary cancer detection with cancer screening programs such as Mammograms, PSA screening, bowel cancer screening).

Cancer patients are quite often aware of own body and pre-existing aches and pains.

The best thing is to act promptly if there are “any new and persistent symptoms” . For vast majority of cancer patients, there is no need to do a frequent check list of possible symptoms, on a daily or weekly interval.

Do NOT be on constant vigilance for all possible cancer symptoms unless you have been specifically advised to do so by your oncology team.

Eternal Vigilance for months and years can wreck your quality of life.

Think Positive. Nothing is lost when you maintain hope.

References

BBC news . https://www.bbc.co.uk/news/health-49999404

‘Unacceptable’ delays in diagnosing secondary breast cancer

The standard disclaimer is very relevant to this blog.

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.

Blaming the tools

Tools

Any one from any trade would be expected to use the tools of the trade appropriately.

Tweaking the tools unnecessarily or blaming the tools if things do not pan out as planned is generally frowned upon .

Same with medical professionals !

Please contribute your thoughts at BMJ rapid response page.

Interpreting test results: dont blame the tools

Access the article at: http://bmj.com/cgi/content/full/bmj.m1162

Toll-free link:
http://bmj.com/cgi/content/full/bmj.m1162?ijkey=sZarWS4YlJf9NS0&keytype=ref

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.

Plain English Medical Letters to Patients

Writing letters to patients in plain English without medical jargon is a gift that only a few doctors possess.

Personalising complex medical terminology in a letter dictated over a few minutes is NOT an inherent skill possessed by many doctors including those who are native English speakers.

Dictating Plain English medical letters would take considerable time and effort – particularly if letters are going to succinctly summarise everything from a medical consultation.

In UK, with regards to Cancer, we are lucky to have cancer charities who do a good job of providing information in plain English ( E.g Cancer Research UK, Macmillan Cancer Support, Prostate Cancer UK).

Cancer Patients in UK also have the support of Cancer Nurse Specialists ( CNS ) who do a fantastic job of guiding patients through their cancer journey and clarify all medical jargon to patients.

Other specialities might not have the resources that are available to cancer patients. But, on the whole, Clinic Time slots are precious. Many UK specialists have long waiting lists.

So if further time and effort is to be expended in busy clinics for dictating plain English Letters – in addition to the usual Medical letters to GP – good clinical evidence is needed to demonstrate that separate plain English letters do benefit patients in a meaningful way.

Please do read the BMJ article and put forward your views in the rapid response section.

Access the article at: http://bmj.com/cgi/content/full/bmj.m949

Toll-free link:
http://bmj.com/cgi/content/full/bmj.m949?ijkey=nxJ9CdIVHKZW1Jd&keytype=ref

Disclaimer:

The views expressed here are my personal views and do not represent the views of any other professional organisation I am associated with…

Walking is good exercise

New year. January. First month of a New year – it’s the time of year many people take a look at their lifestyle and vow to eat better, exercise better and live better.

Many people consider Gym or Health Club membership.

But Exercise doesn’t need to cost a lot. Being active, doesn’t need to be regimented.

Simply walking anywhere is good compared to no exercise at all. Walking in the Park or Quiet streets has lot of benefits.

Good article in BBC on the benefits of walking.

A word of caution though !

Avoid Walking or Jogging near busy roads so that the benefits of walking are not negated by pollution.

Reference

1. BBC. 8 reasons why we should all walk more. BBC.

2. Guardian. Traffic fumes in city streets ‘largely wipe out exercise benefits for over-60s’.

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.

Futile antibiotic treatments

Infections are normally highly treatable with antibiotics.

But when someone is dying , the body’s immune system gets weaker. Hence infections quite often occur as part of the dying process.

Treating these infections are often futile. But human nature is inclined to “fight and survive” by all means. So quite often powerful antibiotics are used to treat these infections in dying patients.

There is an ethical argument against futile treatments.

There is also the risk of antibiotic resistance in general population if antibiotics are used inappropriately.

Submit your views at BMJ journal website (rapid response section).

References

Access the article at: http://bmj.com/cgi/content/full/bmj.l6706

Toll-free link:

http://bmj.com/cgi/content/full/bmj.l6706?ijkey=ZXN1zz6QXpPz8np&keytype=ref

Can long working hours kill you?

Yes, it can.

It has been well established by systemic review that working long hours can lead to excessive heart attacks. ( ref 1).

A recent French study indicates that working long hours can lead to increased risk of stroke ( Long hours defined as more than 10 hours on at least 50 days per year in this study) (ref 2).

So look after yourself and don’t push yourself too hard !

References

1. Long Working Hours and Coronary Heart Disease: A Systematic Review and Meta-Analysis .

2. Long working hours ‘linked to stroke risk’ BBC News.

“Think Positive “ and live longer !

People with sunny disposition seems to live longer.

Having a positive outlook on life seems to protect heart.

Is it a case of “chicken vs egg” in that what came first. Do healthy people have a optimistic outlook and pessimistic people have lot of social, personal and health problems. Do life problems make people pessimistic or being optimistic makes one do better?

Researchers have adjusted the data for confounding factors. Evidence so far is very intriguing.

And the next question is – can one learn to be optimistic, change personality and have beneficial health effects. We don’t know at present.

References

1. Guardian. Optimists have lower risk of heart problems and early death.

2. Guardian. Optimism may hold secret to longer life, study suggests.

3. The association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA)

4. JAMA. Association of Optimism With Cardiovascular Events and All-Cause Mortality

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.

Veliparib : Another new drug for treatment of Ovarian Cancer

Veliparib trial data has certainly brought more options to the table in treatment of advanced Ovarian cancer.

Trial data presented at ESMO congress at Barcelona shows that first line therapy with Veliparib is beneficial.

Acknowledgement: Copyright of Slides: Authors and ESMO

References

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.

New drug combination for Ovarian Cancer (Olaparib and Bevacizumab)

New trial data presented at the ESMO cancer Congress 2019 in Barcelona, Spain, show excellent results for the combination of Olaparib and Bevacizumab. The combination looks likely to become standard of care in at-least a subgroup of patients.

The expert discussing the trial data did raise the possibility that most benefit seems to come from Olaparib in patients with BRCA mutations and whether Olaparib alone instead combination is enough for this group. More data is awaited.

References

1. ESMO 2019 congress press release. Ovarian Cancer: More Women Benefit from Maintenance Combined Targeted Therapy [ESMO 2019 Press Release]

Acknowledgement: Copyright of Slides: Authors and ESMO

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.

Niraparib : New treatment for new diagnosed Ovarian Cancer

A landmark study presented at ESMO congress at Barcelona shows significant benefits for maintenance treatment with the drug Niraparib.

Niraparib is likely to become a standard treatment in a much more widely group of advanced ovarian cancer patients.

Many clinicians will be weighing up Niraparib Vs Olaparib in Some patients and Niraparib vs Bevacizumab in other groups of patients.

Reference

1. Niraparib Prolongs PFS in Patients with Newly Diagnosed Advanced Ovarian Cancer. ESMO press release.

Acknowledgement: Copyright of Slides: Authors and ESMO

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.

Exercise: Anything is better than nothing

Many people put off exercise thinking it needs to be a planned activity with time allocated for it.

A paper published in British Medical Journal ( BMJ) reports that any exercise is good and contributes to good health compared to no exercise

The recent UK guidelines also advises to “clock up few minutes at a time” whenever and wherever you can. (UK Chief Medical Officer).

You don’t need to run a marathon or join a running group. Just taking the stairs rather the lift would be good.

References

1. Guardian. Even a few minutes’ exercise is good for you, new guidelines state.

2. BMJ. British Medical Journal. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4570 (Published 21 August 2019)

Cite this as: BMJ 2019;366:l4570

3. Daily Telegraph. No such thing as too little exercise, says Chief Medical Officer, as ten minute minimum is scrapped.

4. BBC news. Strengthen muscles as well as heart to stay fit and healthy, say top doctors

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.

Celery Juice: Super Juice ?

Why Celery Juice is popular now?

Every year some type of food or fruit trends on the social media after being hyped by celebrities and Influencers.

Unfortunately, it seems Celery Juice is trending now.

Just because something is endorsed with good intentions by well meaning people doesn’t mean you have to blindly believe them.

Read the BBC news article for a balanced account .

Reference

1. Celery Juice: The big problem with a viral Instagram ‘cure. BBC news.

Is Vegan diet the most healthy ? Are there any risks from Vegetarian diet?

Life would be very simple if we can have clear cut answers with regards to the best diet for everyone’s health.

A recent study published in BMJ indicates that while Vegan diet reduces risk of heart problems it can increase the risk of strokes.

The results might seem confusing and scientists would be certainly seeking more answers. But don’t be surprised if another study from some other research group comes up with a contradictory result. That’s normal in science.

What’s most important is to realise that there are no easy scientific answers to most scientific questions. Research quite often shows unexpected results. What is a logical scientific question quite often throws up unexpected answers.

Overall, the message is “have a well balanced diet” without omitting essential nutrients.

References

1. BBC news. Plant-based diets ‘linked to higher stroke risk‘ Vegan and vegetarian diets ‘link to higher stroke risk’ Sept 2019.

2. BMJ. British Medical Journal.

Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4897 (Published 04 September 2019)

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.

Does Cranberry juice relieve bladder symptoms due to radiation cystitis?

bowl of red round fruits

Many people do look for natural remedies to help with their symptoms.

Anectodally, many patients undergoing radiotherapy have reported that Cranberry Juice has eased their radiation cystitis symptoms.

What is the scientific evidence behind it ?

Should all patients having cystitis symptoms during radiotherapy take cranberry juice?

There is certainly scientific basis to expect benefit from Cranberry Juice.(1).

A lab study and a volunteer study (with volunteers from Japan, Hungary, Spain and France) has shown that certain chemicals in Cranberry can make bacteria ‘less sticky‘ to urinary tract walls and hence potentially reduces virulence of the bacteria.(1). But subsequent large studies have NOT confirmed any large benefit from Cranberry in terms of treating or preventing urinary tract infections. (2)(3).

But Radiation Cystitis is not due to bacterial infections although infections can co-exist sometimes. Hence the use of Cranberry has been studied separately in patients undergoing radiation therapy.

A New Zealand study involved 41 men undergoing radiotherapy for prostate cancer. Taking Cranberry (one capsule a day at breakfast) was found to reduce symptoms of pain and burning. (4).

On the other hand, in a study from Canada involving 112 patients , consumption of Cranberry juice compared with apple juice had no effect on radiation cystitis symptoms. (5).

Another study from United Kingdom was inconclusive because of poor patient recruitment and poor compliance. (6).

So the scientific evidence is inconclusive at present.(7).

Practically, if someone is keen to try it – the best course of action – ( for someone not intolerant of cranberry juice) – is to try it and see whether it offers any symptomatic benefit .

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

There are prescription medications available to help with radiation cystitis symptoms.

References:

1.Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010 Apr 14;10:94.

2. BBC News. Does Cranberry juice stop cystitis. By Claudia Hammond. (Accessed 1st Jan 2019).

3. BBC News. Ditch cranberry juice for urine infection . (Accessed 1st Jan 2019).

4.Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer (2015) 23: 95.

5. A Randomised Trial of Cranberry Versus Apple Juice in the Management of Urinary Symptoms During External Beam Radiation Therapy for Prostate Cancer. G.Campbell et al. Clin Oncol (R Coll Radiol). 2003 Sep;15(6):322-8.

6. A Randomised Double-blind Placebo-controlled Trial to Determine the Effect of Cranberry Juice on Decreasing the Incidence of Urinary Symptoms and Urinary Tract Infections in Patients Undergoing Radiotherapy for Cancer of the Bladder or Cervix. Cowan CC, et al. Clin Oncol (R Coll Radiol). 2012.

7.Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges. BJU Int. 2013 Nov;112(7):885-97.

Image credit: Photo by Jessica Lewis on Pexels.com

www.sundar.blog

 

stetchscope pen laptop

Hi,

This blog will be a commentary on health related news with particular focus on clinical studies involving the cancers I treat. (my profile: https://sundar.uk ).

Disclaimers first:

  1. This blog cannot provide personal medical advice. Medicine is incredibly complex and nothing is absolute, and everything depends on individual circumstances. So always consult your own oncologist.
  2. Remember modern medicine is ever changing and the “only thing that is permanent is change itself”. That’s why new evidence sometimes completely contradicts conventional wisdom and practice.  Don’t be surprised if scientific studies contradict each other.
  3. To avoid anyone inadvertently disclosing personal or confidential information, comments will be disabled.
  4. The views expressed here are strictly personal and the views do not in any way whatsoever reflect the views or policies of the many professional organisations I am associated with.

Sundar

www.sundar.blog