Primary breast cancer can 'shut down its own spread'

Breakthrough research shows that primary breast cancer has the ability to "essentially shut down its own spread." These findings may help "freeze" cancer cells before they get chance to form secondary tumors.

                         

Breast cancer cells (shown here) can break away from the original tumor and travel to the rest of the body. A new study shows how to stop them.

According to the National Cancer Institute (NCI), in the United States, a total of 266,120 women will be diagnosed with breast cancer in 2018.
Almost 41,000 of these cases will result in death.
However, as the NCI show, the number of breast cancer deaths has been steadily decreasing since the early 1990s.
Overall, the 5-year survival rate for breast cancer is now close to 90 percent.
After receiving a breast cancer diagnosis, a person's outlook is influenced by several factors — the most important of which is the extent of the cancer and whether it has spread beyond the original site of the tumor.
For instance, the 5-year survival rate for women with stage 2 breast cancer is approximately 93 percent. However, once the cancer has spread — or metastasized — this number drops to 22 percent.
As a result, more and more researchers have been focusing on the process of metastasis in the hope that a better understanding of it will lead to better strategies for prevention.
New research, published in the journal Nature Cell Biology, sheds such light on the process of metastasis in breast cancer, uncovering a previously unknown aspect of it.
Primary breast tumors, the new study shows, have the ability to stop themselves from spreading.
The scientists who conducted the research were jointly led by Dr. Sandra McAllister, from Brigham and Women's Hospital and Harvard Medical School, both in Boston, MA, and Dr. Christine Chaffer, from the Garvan Institute of Medical Research in Sydney, Australia.

Tracking down 'breakaway cancer cells'

With their team, Drs. McAllister and Chaffer conducted experiments in mice and human tumors. In a rodent model of breast cancer, they found that primary tumors have the ability to stop the "breakaway" cancer cells from traveling to other sites in the body.
The primary tumor does this by triggering an inflammatory response from the immune system. Once activated, the immune system dispatches "search patrols" of immune cells throughout the body. The main role of these cells is to find the locations where breakaway cells may be trying to settle and create new tumors.

Breastfeeding reduces risk of stroke in mothers: JAHA

Breastfeeding is not only beneficial for babies, a new study published in the Journal of the American Heart Association, has found that breastfeeding may also protect the woman from a stroke later in life.

Lisette T. Jacobson, assistant professor, University of Kansas School of Medicine, Kansas, U.S., and colleagues conducted the study to assess the association between breastfeeding and stroke and to determine whether this association differs by race and ethnicity.

This is among the first studies to examine breastfeeding and a possible relationship to stroke risk for mothers, as well as how such a relationship might vary by ethnicity.

According to the study, stroke is the fourth leading cause of death among women aged 65 and older and is the third leading cause of death among Hispanic and black women aged 65 and older.

“Some studies have reported that breastfeeding may reduce the rates of breast cancer, ovarian cancer, and risk of developing Type 2 diabetes in mothers. Recent findings point to the benefits of breastfeeding on heart disease and other specific cardiovascular risk factors,” said Jacobson.

Clinical Implications

    Breastfeeding along with other risk factors or risk markers during women’s reproductive years may be associated with stroke risk later in life. Identification of risk factors may help healthcare providers in assessing a woman’s risk profile.

    The medical and behavioral science communities may be better able to design culturally informed programs that mitigate stroke risk while they promote healthy lifestyle behaviors including breastfeeding among populations that unduly carry the largest health burden of stroke.

    Further investigation into the association and dose‐response relationship between breastfeeding and lower risk of stroke among postmenopausal women is warranted.

Researchers analyzed data on 80,191 participants in the Women’s Health Initiative observational study, a large ongoing national study that has tracked the medical events and health habits of postmenopausal women who were recruited between 1993 and 1998. All women in this analysis had delivered one or more children and 58 percent reported ever having breastfed. Among these women, 51 percent breastfed for one-six months, 22 percent for seven-12 months and 27 percent for 13 or more months. At the time of recruitment, the average age was 63.7 years and the follow-up period was 12.6 years.

Key Results:

    After adjusting for non-modifiable stroke risk factors (such as age and family history), researchers found stroke risk among women who breastfed their babies was on average:

         23 percent lower in all women

        48 percent lower in black women

        32 percent lower in Hispanic women

        21 percent lower in white women

        9 percent lower in women who had breastfed for up to six months.

“If you are pregnant, please consider breastfeeding as part of your birthing plan and continue to breastfeed for at least six months to receive the optimal benefits for you and your infant,” Jacobson said.

“Our study did not address whether racial/ethnic differences in breastfeeding contribute to disparities in stroke risk. Additional research should consider the degree to which breastfeeding might alter racial/ethnic differences in stroke risk,” Jacobson said.

Because the study was observational, it couldn’t establish a cause-and-effect relationship between breastfeeding and lower stroke risk, meaning that it is possible some other characteristic that distinguishes between women who breastfeed and those who don’t is the factor changing the stroke risk. However, because the Women’s Health Initiative is large, researchers were able to adjust for many characteristics, and the effects of breastfeeding remained strong, Jacobson said.

“Breastfeeding is only one of many factors that could potentially protect against stroke. Others include getting adequate exercise, choosing healthy foods, not smoking and seeking treatment if needed to keep your blood pressure, cholesterol and blood sugar in the normal range,” Jacobson said.

The study was also limited by the relatively small number of strokes that occurred during the follow-up period (just 3.4 percent of the women experienced a stroke during the study period and 1.6 percent reported having had a stroke prior to the study) and by the Women’s Health Initiative’s exclusion of women who had already had severe strokes at the time of recruitment.

Currently, the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for six months, with the continuation of breastfeeding for one year or longer. For babies health, the American Heart Association recommends breastfeeding for 12 months with a transition to other additional sources of nutrients beginning at about four-six months of age to ensure sufficient micronutrients in the diet.

“Study results show an association and dose‐response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted,” concluded the authors.

For more information follow the link: https://doi.org/10.1161/JAHA.118.008739

Read more at Speciality Medical Dialogues: Breastfeeding reduces risk of stroke in mothers: JAHA

Mental disorders are treatable.

Story of Govinda will inspire everyone working in the field of mental health. Mental diseases are both treatable and in many cases curable. 

A three-drug combo pill lowers BP more than usual care

A new low-dose antihypertensive combination drug, containing medications belonging to different class, may have the potential to revolutionize treatment of hypertension globally. This ‘triple pill’ contains three antihypertensive drugs: Telmisartan (20 mg), amlodipine (2.5 mg) and chlorthalidone (12.5 mg).
A randomized clinical trial, the TRIUMPH trial, which was conducted in Sri Lanka compared once-daily low-dose triple antihypertensive combination drug with usual care in 700 patients with  with mild to moderate hypertension, who needed either initiation (untreated patients) or escalation (patients on monotherapy) of antihypertensive therapy.  In usual care, patients received their doctors choice of blood pressure-lowering medication.
Among 700 randomized patients (mean age, 56 years; 58% women; 29% had diabetes; mean baseline systolic/diastolic BP, 154/90 mm Hg), 675 (96%) completed the trial.
In the study published August 14, 2018 in JAMA, 70% patients in the triple pill group achieved the BP targets of systolic/diastolic BP of less than 140/90 mm Hg (or <130 55="" care.="" chronic="" compared="" diabetes="" disease="" hg="" in="" kidney="" mm="" or="" p="" patients="" receiving="" usual="" with="">The maximum difference between the two treatment groups was observed at six weeks after starting treatment, when 68% of those receiving the triple pill had achieved their target BP vs 44% of those receiving usual care. The average reduction in blood pressure was 8.7 mm Hg for participants receiving the triple pill and 4.5 mm Hg for those receiving usual care. The benefits of triple pill were maintained until six months. No significant between-group differences were observed in the proportion of patient withdrawal from BP-lowering therapy due to adverse events; 6.6% for triple combination pill vs 6.8% for usual care.
Based on these findings, the study concluded that use of medication, such as the ‘triple pill’ used in this study, as initial therapy or to replace monotherapy may be an effective way to improve BP control. It was also safe.
Hypertension is a common and most important risk factor for cardiovascular disease. The low and middle income countries, in particular, bear a significantly high global burden of hypertension, making it a major public health problem these countries.
There are several barriers to effective control of high BP, including lack of adequate resources, limited access to treatment and most importantly, poor patient compliance to treatment due to the need to take multiple pills daily.
The triple pill offers a useful strategy to control the high burden of hypertension, especially in the low and middle income countries. Combining the anti-hypertensive drugs in a single pill would make it easier both for doctors to prescribe treatment and more importantly for patients to adhere to the prescribed treatment.
(Source: JAMA, ACC)

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

Epidural Hematoma leading to paraplegia: Delhi HC upholds MCI suspension of Gynaecologist

 

New Delhi: Through a recent judgment, the Delhi High court upheld the Medical Council of India order calling for removal a gynecologist’s name from the Indian Medical Register for 15 days. This came after the council held her guilty of negligence in providing post-operative care to a patient after childbirth, which left her suffering from a permanent paraplegia. The Delhi High Court had upheld the said decision after the doctors challenged the MCI’s order.

The case concerns a patient, who was admitted for childbirth under the care of Dr Meena Harsinghani, a gynecologist and obstetrician by profession at Deepak Nursing Home. She was consulting Dr Meena since her pre-natal period.

After examination, the doctor informed the patient that the fetus had passed meconium in the uterus and that could be dangerous, as the fetus could breathe the meconium into his /her lungs. Therefore, she was rushed to the operation theatre in emergency.

As the anesthesiologists on the panel of the nursing home were not available, Dr Narayan Harsinghani, Dr Meena’s husband, an anesthesiologist administered anaesthesia in the spine of the patient. The patient delivered the baby without any further complications. However, she complained of severe pain in the back and heaviness in the lower part of her body.

She was examined on the next morning, which was around 14-15 hours after the operation. Subsequently, a consulting neurologist, Dr Nirmala Lahoti advised treatment including steroids and physiotherapy and advised an MRI in case of poor response to the steroids. The MRI showed that she had suffered from an epidural haematoma, a post-spinal anesthesia complication leaving the patient with permanent paraplegia.

Aggrieved with the fact that if the complication had been discovered at an earlier stage, she wouldn’t have suffered the paralysis, the patient filed a complaint with the Delhi Medical Council (DMC) alleging that after the delivery of the baby, neither the gynecologist nor the anesthetist checked her leg movement and sensation to ascertain whether power had come back. She stated that she had severe pain in her spine and thighs but the doctors took it very lightly.

After hearing the complaint, the Disciplinary Committee of DMC observed that the treating team failed to assess the gravity of the clinical condition of the complainant.

The committee concluded that the doctor couple had failed to exercise the reasonable degree of skill, knowledge, and care, as was expected of an ordinary prudent doctor, in the treatment administered to the patient at the Nursing Home. Accordingly, it recommended that the names of the petitioners be removed from the State Medical Register for a period of 15 days.

While observing the recommendation made by the committee, the DMC held, “In this case error of judgment constituted an act of medical negligence,” and directed the suspension. In response, the doctors moved the MCI, preferring an appeal against the said order.

Before the Ethics Committee of MCI, the doctors asserted that the patient had complained of the heaviness of limbs only in the morning of 29.11.2008. She was thereafter, examined by Dr Narayan, who found some movements in both the limbs. The doctors emphatically stated that Dr Lahoti had advised a conservative treatment and had not advised an MRI.

Dr Lahoti refuted the statement and reiterated that she was called for consultation about 18 hours after administration of anesthesia. “By that time the Complainant had already suffered maximum neurological damage,” she added. In addition, she alleged that the medical records had tampered.

After considering the submissions made by all the parties, the Ethics Committee of the MCI concluded,