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Thursday, December 01, 2016

Invited post on Pericardial mesothelioma

Pericardial Mesothelioma 


Many doctors and researchers consider that asbestos fibres and dust are the major pericardial mesothelioma causes. Pericardial mesothelioma originates from the heart’s lining or the pericardium. Everyone out of 20 mesothelioma cases would turn out to be pericardial mesothelioma. A healthy pericardium provides protection and support to the heart. However, pericardial mesothelioma leads to the buildup of fluid around the heart and this exerts a great amount of pressure on the patient’s heart, which leads to pain and numerous symptomatic problems.

Asbestos Fibers and Pericardial Mesothelioma

Doctors and researchers are yet to establish or understand the causal relationship between pericardial mesothelioma and exposure to asbestos fibres or dust fully. Nevertheless, most patients that are diagnosed with pericardial mesothelioma have an asbestos exposure history. However, the rarity of pericardial mesothelioma hinders researchers from analysing this causal relationship comprehensively. Based on the reported cases, however, researchers have come up with an explanation for this relationship. 

How asbestos fibres and dust cause pericardial mesothelioma

Asbestos fibres are inhaled or ingested during asbestos exposure after which they travel through the bloodstream and become lodged in the pericardium or the membrane that surrounds the heart. Once lodged in this membrane, the body finds their elimination extremely difficult. Thus, the fibers remain stuck in this membrane for a long period. However, they cause the cells and tissues to undergo changes during this period and this causes cancer.
Ideally, the lodged asbestos fibres turn normal cells into cancerous cells. Cancerous cells divide abnormally or more rapidly without restraint or regulation as it is the case for the growth of normal or healthy cells. Continuous growth of mesothelioma cells lead to thickening of the heart’s lining and eventual development of tumours. Changes in the pericardium lead to fluid buildup between pericardial layers. When fluid buildups and thickening of the pericardium are combined, they exert more pressure on the heart. 


A patient may experience the following symptoms of mesothelioma once fluid builds up around the heart and starts exerting pressure on this vital organ:
ü  Heart palpitations
ü  Chest pain
ü  Persistent coughing
ü  Shortness of breath

These symptoms are similar to those of other ailments such as heart failure. As such, there are many cases of misdiagnoses which lead to the discovery of this disease at its advanced stages. Nevertheless, pericardial mesothelioma diagnosis can be done after a careful examination of the patient to determine whether additional testing is required. Generally, pericardial mesothelioma diagnosis is confirmed after tests like fluid and tissue biopsies which enhance the detection of mesothelioma cancer cells. After diagnosis, doctors determine the stage or progress of mesothelioma. This includes determining the extent to which the cancer has invaded tissues and organs that surround its point of origin. All tumours are located before appropriate treatment methods are determined.

Treatment Options

Since pericardium rests closely to the human heart which can easily be damaged by most therapies, pericardial mesothelioma has limited treatment options. Although surgery is mostly used to treat mesothelioma cancer, most pericardial mesothelioma patients cannot undergo surgery. Nevertheless, there are cases where this cancer is diagnosed in its early stages and surgery performed to remove the localised, small tumours. Other treatment options for pericardial mesothelioma include chemotherapy and palliative treatment.


Saturday, August 20, 2016

What to do when you see a rash on your child

Rashes are any spots or blotches that appear on the skin. They can be of different kinds. Each kind of rash has a medical name, but we will try and talk about this without using jargon.

This post is about rashes that occur in an ill child. We are going to ignore rashes that have been present for a long time, and most probably represent a skin condition needing the attention of a skin specialist (dermatologist). We are also going to stay away from spots that occur due to any condition in the newborn period.

Having said that, this discussion is mostly about spots or rashes that appear acutely, and are a hallmark of an acute medical condition that needs urgent attention. We will be speaking about rashes that indicate infection, and rashes that are actually bleeds in the skin and may indicate EITHER an infection, an immune condition, a bleeding disorder or even a malignancy.

Let me begin by talking about spots that occur in a child presenting with fever, reduced feeding, or/and vomiting of acute onset. There are TWO main kinds of rashes - from the point of view of their being harbingers of something serious. A BLANCHING rash is rash that disappears when you press it with a transparent item such as a plastic or glass plate. A NON-BLANCHING rash is one that DOES NOT similarly disappear. Between the two, a blanching rash is more likely to be a benign one, and may suggest a viral infection. A non-blanching rash is the one to be taken seriously. It may be a harbinger of infection with a particularly fast-attacking germ that is called the MENINGOCOCCUS. It can cause sepsis or meningitis very very quickly and can kill the affected child within hours when it is severe. This infection is more common in the west, although, with time, its incidence is likely to decline since vaccination is now available against most of the kinds of this deadly organism.

The test described above to differentiate between the two kinds of rashes is called the GLASS TEST. Every parent should be aware of this test and know how it is to be done. - The Glass Test
Important disclaimer: A rash is harder to see and understand in someone with dark skin. Always contact your doctor if you are unable to understand the rash.

Coming to bleeding rashes in the skin. These can be pin-point like or large blotches that are raised above the level of the skin. Both  these rashes can be the rash of meningococcus described above. However, they can also indicate a bleeding condition such as a defect in the function of the coagulation system of the body, a platelet disorder or a blood cancer. Whenever you see someone who has one of these skin rashes, please contact the doctor or your health representative urgently, and within an hour if feasible, especially if the child has been unwell.

I hope this helps you to understand rashes on the skin of an acutely unwell child better. Thank you for reading this post. Do leave your comments.

Remember  to click on the links above for more information on the subjects therein.

Wednesday, June 01, 2016

Building a strong immunity in children

A lot of people worry about this issue, so I thought I should tackle this here. The most important thing to know is that our body;s defensive abilities lie in the correct structure and function of our immune system. This system consists of several specialised organs including the bone marrow, lymph nodes, spleen, thymus and so on. These structures are all present even in a pre-term baby, but their functioning is not something that is optimal at that time. It is over a period of months inside the mother's uterus and then years in the world outside that the immune system develops into a mature system that can prevent and fight infections and other assaults on our bodies.

A strong immune system that can prevent the child from falling ill depends 
upon many things. One of these is the maturity of the system itself. As I have said, the more preterm a baby is, the less his/her immune system's development is, so that it makes sense to prevent premature births. The second most important thing is breastfeeding by the mother. This is so important that its significance cannot be underestimated. The milk of the mother is precious at all times, but even more so during the first few days after the baby has delivered. This milk is called COLOSTRUM. It looks yellowish, watery and not at all like the milk we see in bottles and in packs in the supermarket. It is very small in quantity, perhaps about 60-100 ml in all - but it is packed with antibodies and many important ingredients that help the baby to arm up against several kinds of infections right up to the end of the first year of life. We are still learning about the magic of mother's milk, and I won't be the least surprised if we discover that the benefit of mother's milk goes substantially beyond the baby's infancy.

The next most important factor that determines a child's immunity is their diet. A diet that is well-balanced and contains adequate amounts of all the essential food elements goes a long way in keeping the baby or the child fit and fine. Among the various factors in food that are important from the immune system's health point of view are the amounts of micro-nutrients and vitamins in the diet. Such adequacy can only come if the child is given substantial quantities of salad, fruit and dry fruit and protein-rich foods in the diet. 

Yet another potent immune-protector is proper hand washing by the child. While hand washing does not actually boost the child's immunity, it helps to prevent a lot of infections that can be spread through our inanimate environment.

And, to end this story, I am going to chip in a few lines on immunisation. This means vaccinating the child against a myriad range of infections. Most such activities take place during the first few years, but periodic immunisations continue throughout a child (and then, young person)'s life.These vaccines provide a mix of active as well as passive immunity against infections of all kinds. 

Acute Bronchiolitis in Infants and Young children

Most people have not heard of this exact word in developing countries. The word "bronchiolitis" means inflammation of the BRONCHIOLES. What are bronchioles? These are the smallest size airways in our lungs. They lead out from bigger airways known as bronchi and end into our air-sacs or what we call the ALVEOLI, where the crucial gas exchange of oxygen and carbon dioxide takes place thousands of times in a day, and throughout our life. 

Because infants have small bodies and small lungs, they also have very small bronchioles. These bronchioles catch infection with viruses very easily, and when they do, they get swollen, their internal diameter gets smaller, and their ability to allow effective gas exchange to take place gets reduced dramatically. 

When this happens, the baby becomes short of breath, as he/she can no longer breathe in and out without effort to push open the bronchioles with each breath. The breathing rate goes up, the baby works hard, and soon, he/she becomes tired. This chain of events is known as acute bronchiolitis. While usually a self-limiting condition, infants with this problem can sometimes become really sick and need hospitalisation. We will come to that a little later.

Acute bronchiolitis is an illness most commonly seen during the coldest months of the year. It begins with a simple cold - a runny nose, sniffles, a mild cough and perhaps a bit of a temperature. Over the next few days, the virus descends downwards from the upper airways into the lungs. When it reaches the smallest airways or the bronchioles, it produces inflammation - swelling and secretions in the tubes. This is when the child begins to be short of breath. He/she breathes more rapidly. At this stage, the illness can either remain static, and the child will have the breathing difficulty but not look very sick; or, it can become progressively more severe, and the child may become so breathless as to be unable to feed, sleep or look well. The severity may be such as to make the child's carers reach out to the doctors, with a visit to the hospital in the more serious ones. 

As this is a viral illness, and most of the times resolves by itself, doctors attending to infants and small children with acute bronchiolitis don't usually admit the child unless his/her blood oxygen levels are falling or the child is getting progressively more and more tired. Once admitted, such infants are treated with oxygen and nutritional support. Little else is helpful or needed/ Some infants may be given additional forms of treatment with medicines that open up their airways and make them breathe more easily. However, this is an exception and not the norm. 

Once the breathing difficulty is under control, infants and small children with acute bronchiolitis are ready to go home. Some of them will need medicinal support for slightly longer. A few of the infants who recover from their first attack might develop recurrences of a similar attack repeatedly. A very small percentage of such repeat-afflicted ones may develop an asthma-like chronic problem.

To summarise: Acute bronchiolitis is a frequent problem characterised by a breathing difficulty with a self-resolving natural course. Caused by viruses, it is not an illness that usually causes much distress or loss of productivity on the part of parents. Treatment is directed at maintaining the oxygenation and hydration of the affected child and allow him/her to recover on their own.

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