Triple Marker Test

Oral cancer (OC) occurs when DNA mutations develop in the cells lining the lips and the mouth cavity. It commonly affects the tongue, floor of mouth, buccal mucosa, lips, palate, gum etc all. Mostly, oral cancers are squamous cell carcinomas that begin in the squamous cells lining the lips and the inside of mouth.

1. Type: of oral cancer are as enumerated below -

   1. Squamous cell carcinoma: is the most common, as described above.

   2. Adenocarcinoma: affects the salivary glands.

   3. Lymphoma: affects the tissues of the tonsil(s) or those involving the lymphatic system.

   4. Melanoma: may affect the mucous tissues of the oral cavity.

2. Gender: affects the male populace predominantly. But, it can affect both male and female. It’s the commonest cancer in India currently, and accounts for a significant percentage of the total cancer mortality.

3. Etiology: consumption of “khaini” (tobacco & lime mix), betel nut, areca nut, slaked lime, chronic irritation due to irregular teeth, smoking, alcohol consumption, oral infection with Herpes Simplex Virus (HSV) / Human Papilloma virus (HPV), nutritional deficiencies, chronic infections & poor dental/ oral hygiene are the common risk factors that can trigger oral carcinogenesis. It is noteworthy that the local effects of tobacco and alcohol are both dose-dependent and synergistic.

4. Features: the various presentations (of signs & symptoms) of Oral cancer are as given below –

   1. Cheek cancer - hard and painless thickening, with an ulcer sometimes that does not heal for weeks together.

   2. Lip cancer - white patch on the inner lining of the lip on which a hard mass slowly develops.

   3. Palate cancer- persistent sore on the hard palate that may ulcerate.

   4. Throat cancer - difficulty swallowing, sore throat, voice changes, feeling of hard lump in the throat.

   5. Tongue cancer - ulcer on the side of the tongue that bleeds occasionally and does not heal.

   6. Gum cancer and cancer of the minor salivary glands - loose teeth, bad breath and sensory loss of the feelings in the face

5. Screening: is generally recommended for asymptomatic populations goal of which, as usual, is to be able to detect & diagnose oral cancer at an early stage which is potentially curable. Visual screening by healthcare personnel including dentists, general practitioners, oncologists, surgeons etc all is crucial to detect not only early asymptomatic oral cancers but also the oral pre-cancerous lesions including oral submucous fibrosis (OSMF), oral leukoplakia, erythroplakia et al which carry a high risk of malignant transformation to in-situ and invasive cancers.

6. Diagnosis: a complete physical exam of the local parts basis the features mentioned above arouses suspicion that prompts diagnosis -

   1. Biopsy (punch or removal of mass of tissue (excision) for cytology) clinches the diagnosis of oral cancer. Should there be a neck mass that arises suspicion of a regional metastatic disease, a fine needle biopsy (FNB) can be attempted.

   2. Initial staging workup includes CT, MRI scans etc all. PET CT scan though frequently employed, is not usually used for the initial workup.

   3. A triple endoscopy that includes laryngoscopy, esophagoscopy and bronchoscopy can help definitive staging of the disease. Biopsies obtained during this procedure help confirm the primary diagnosis, define the extent to which the primary site disease has spread, and identify additional pre-malignant lesions and metastasis, if any.

7. Treatment / Prognosis: preventive measures, earlier diagnosis and right early treatment is key for better prognostication and efficient/ effective therapeutic management of oral cancer. Conventional treatment includes surgery, radiotherapy, chemotherapy as deems appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical endpoints and facilitate recovery as would be feasible contextually. As seen with other cancers, the site, stage, histopathological grading etc all determine the treatment outlook. The number of micronucleated oral mucosal cells can be a useful biomarker for predicting course of oral pre-cancerous lesions and prognosis thereof.

8. Prevention: rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an increased focus on protective factors and avoidance of the risk factors can be of help. Especially, abstaining from use of tobacco/ products, alcohol, regularly maintaining oral health and hygiene and daily intake of fresh seasonal fruits and vegetables can help prevent a vast majority of oral cancers. Also, timely screening/ detection of the pre-cancerous lesions of the oral cavity and prompt treatment thereof is crucial to preventing a malignant transformation of the same. If you wish to discuss about any specific problem, you can ask a free question.

Ayurveda is an everyday life science that cures a number of maladies based on the use of herbs, yoga, oil massages and a number of lifestyle tweaks. Ayurveda uses everyday tweaks in order to reach the root cause of the ailment and cure it. Therefore, it makes use of a lot of everyday items that can make changes in the doshas that create an imbalance. Ginger is one such ingredient that has a number of health benefits as per Ayurveda. It is a root spice or flowering plant with an orange brown hue. Read on to know more.

1. Healing Digestive Properties: Ginger has a number of healing properties thanks to its chemical composition as they make it ideal for patients suffering from digestive problems such an irritable bowel syndrome. It also helps in improved production of the digestive juices which can help in flushing out toxins or Ama. This spice also keeps the digestive fires burning due to the heat that it emanates.
2. Nutrition: Ginger also helps in better absorption of nutrients, vitamins and minerals from the food that we eat. This helps in better weight management as well as better digestion, which can prevent a number of diseases including cancer.
3. Stress: Brewing a cup of green or white tea with a hint of Ginger can instantly spread a wonderful fragrance throughout the home and calm your senses by enveloping them. The fragrant properties of Ginger also have a healing effect which can lessen and prevent stress.
4. Nausea: Small doses of Ginger are especially helpful for pregnant women who are suffering from acute and excessive morning sickness or nausea.
5. Muscle Pain: Ginger can be used to reduce pain and soreness in one's muscles. It can be brewed as tea or taken in small slivers after a particularly intense workout. It is also known to help in relieving pain experienced by patients suffering from arthritis and other ailments related to joint and muscles. This condiment also helps in reducing the inflammation in the joints due to its proven anti-inflammatory properties.
6. Diabetes and Heart Disease: Ginger is known to dramatically reduce the blood sugar level. It shows a reduction in the markers for oxidized lipoproteins, which also lowers the risk of high cholesterol and heart disease.
7. Menstrual Pain: Just a gram or two of Ginger can be ingested on a daily basis to get relief from severe pain during menstrual cramps in women.

Ginger can be used to season foods like salads, curries and stir fried vegetables and also for preparing tea so that some quantity can be ingested every day. If you wish to discuss about any specific problem, you can consult an Ayurveda.

Foot problems are common among all people. Some foot problems are minor while some are severe and require immediate medical attention or surgery for treatment.

Here are some common foot problems, which require surgery:

1. Bunions: These are bony lumps, which develop on the side of a foot and also at the base of the big toe. Bunions occur due to a condition called hallux valgus. This causes the big toe joint to bend in the direction of the other toes, resulting in deformity. This condition requires surgical correction. The surgery required is known as osteotomy, and it involves the straightening of the big toe and metatarsals.
2. Hammertoes: Hallux valgus may result in your other toes being clawed or bent permanently. This condition is called hammer toes.

The damage can be eased by:

1. Arthroplasty: It involves the removal of a deformed joint between the toe bones, resulting in joint flexibility.
2. Arthrodesis: This process fuses the phalange and makes the toe stable.
3. Metatarsal surgery: In some cases, the forefoot joints may get damaged due to the inflammation of the joint lining or synovitis, which results in arthritis. These joints are called metatarsophalangeal joints and they can get dislocated due to arthritis damage. Pain and discomfort are felt. Surgery is required when the symptoms are very severe and other treatments fail. The nature of surgery depends on the severity. The most common surgery is done on the big toe to remove the heads of the metatarsophalangeal joints.
4. Ankle arthritis: This condition occurs because of osteoarthritis. The cartilages, which cover the ends of the bones roughen and get thin, which further thicken the bone underneath. It also results because of other rheumatic conditions. Pain and swelling is caused with an occasional joint deformity. Surgery may be required when the symptoms are very severe. The three major surgical options for treating ankle arthritis are ankle fusion, triple fusion and ankle replacement.
5. Achilles tendon disorders: The Achilles tendon accounts for being the largest body tendon and great force is put through it when moving the lower leg muscles. This wears down with old age and causes swellings within the tendon accompanied by pain. Sometimes, surgery is required for fixing this condition.
6. Morton's neuroma: This is a painful condition in which a nerve that gives sensation or feelings to the nearby toes is affected. The nerves are affected in the third and fourth toes. In case the symptoms are severe, a surgery is required.

Foot problems are prevalent in many people and they may occur due to various conditions or reasons. In case of severe symptoms, some foot problems require surgery for treatment. The most appropriate surgical method should be undertaken.

Stomach ulcers are sores that develop in the stomach lining and the small intestine. They tend to form when the digestive juices in the stomach start to corrode the tissues of the stomach. A stomach ulcer is usually diagnosed using an endoscope, a fiber optic tube that is inserted into the throat. This device helps in viewing and identifying the ulcer. Stomach ulcers are easily cured, but they can become severe without proper treatment.

Certain factors and behaviors can put you at higher risk for developing stomach ulcers:

1. Smoking
2. Frequent use of steroids (such as those for treating asthma)
3. Hypercalcemia (overproduction of calcium)
4. Family history of stomach ulcers
5. Being over 50 years old
6. Excessive consumption of alcohol
7. Symptoms of Stomach Ulcers-

The most common symptom is a burning sensation or pain in the area between your chest and belly button. Normally, the pain will be more intense when your stomach is empty and it can last for a few minutes or several hours.

Other common symptoms include:

1. Dull pain in the stomach
2. Weight loss
3. Not wanting to eat because of pain
4. Nausea or vomiting
5. Bloating
6. Burping or acid reflux
7. Heartburn (burning sensation in the chest)
8. Pain improves when you eat, drink, or take antacids
9. Talk to your doctor if you experience symptoms of a stomach ulcer. Even though discomfort may be mild, ulcers can worsen if they aren’t treated.

Treatments
Once the disorder has been diagnosed, the treatments are prescribed. For mild ulcers, medications are prescribed depending on the cause. For example – if the cause of the ulcer is a bacterial infection, then it can be treated with antibiotics. If medications do not help, then surgery may be required.

Initially, antacids may be administered that help in reducing the pain, but this measure only provides temporary relief. The aim of ulcer treatment is to reduce the quantity of acid in the stomach and strengthen the stomach lining. If the ulcer is due to a bacterial infection, then a triple therapy is generally used to treat the ulcer.

What is triple therapy?
The triple therapy is a combination of antibiotics and a proton pump inhibitor that is used in the treatment of ulcer. If medications fail to work, then surgical treatment may be required. In case of ulcer hemorrhage, the source is identified and then treated accordingly. Surgery can also help in reducing excess acid secretion by the stomach. Avoid intake of too much iron supplements as it can cause irritation to the stomach lining. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.

Scarring Alopecia, otherwise called Cicatricial Alopecia, alludes to a gathering of hair loss issue that might be diagnosed in up to 3% of hair loss patients. It happens worldwide in generally healthy men and women of any age.

Every particular diagnosis inside this class is genuinely uncommon, yet a few cases incorporate analyzing Cellulitis, Eosinophilic Pustular Folliculitis, Follicular Degeneration Disorder (beforehand called "Hot Brush" Alopecia), folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq, to give some examples. Scarring Alopecia may likewise be a piece of a significantly bigger condition, for example, Chronic Lupus Erythematosus, where numerous organs of the body can be influenced.

While there are many types of Scarring Alopecia, the normal topic is a conceivably changeless and irreversible demolition of hair follicles and their Replacement with scar tissue.

Most types of Scarring Alopecia initially happens as little Patches of Hair Loss that may extend with time. Now and again the hair loss is steady, without recognizable indications, and may go unnoticed for quite a while. In different examples, the hair loss is related with Serious Itching, Burning, and Pain, and is quickly dynamic.

The Scarring Alopecia Patches normally appear to be somewhat unique from Alopecia Areata in that the edges of the Bald Patches look more "battered." The annihilation of the hair follicle happens beneath the skin surface so there may not be much too really observe on the scalp skin surface other than Patchy Hair Loss. Influenced areas might be smooth and clean, or may have redness, scaling, expanded or diminished pigmentation, or may have risen rankles with fluids or Pus originating from the influenced area.

These visual markers may help with diagnosis; however it is hard to diagnose a Scarring Alopecia just from the pattern of the hair loss and the nature of the scalp skin. Regularly while Scarring Alopecia is suspected, at least one Skin Biopsies are done to affirm the diagnosis and help recognize the specific type of Scarring Alopecia. A little biopsy of 2 to 4 mm in distance across is taken and analyzed under a microscope. A Pathologist or Dermatologist will search for annihilation of the hair follicles, scar tissue deep in the skin, and the presence and area of aggravation in relation to the hair follicles.

Regularly, the early phases of a Scarring Alopecia will have Inflammatory Cells around the hair follicles, which, numerous scientists believe, actuates the demolition of the hair follicles and advancement of scar tissue. In any case, there is some argument about this among Dermatologists, as in some cases a biopsy from a Scarring Alopecia person shows very low irritation.

Scarring Alopecia quite often burns out. The Bald Patches quit growing and any irritation, tingling, burning, or pain goes away. In this end phase; another skin biopsy generally demonstrates no inflammation around hair follicles. Bald areas more often than not have no more hair follicles. Here and there, however, hair follicles, in any event those at the fringe of a Bald Patch, are not totally annihilated and they can re-grow, but rather frequently all that is left are only a couple of Longitudinal Scars deep in the skin to indicate where the hair follicles used to be.

Treatment

Scarring Alopecia can include a great deal of harm and lasting Hair Loss. Hence treatment of Scarring Alopecia ought to be very forceful. The nature of treatment changes relying upon the specific Diagnosis. Scarring Alopecia’s that include for the most part Lymphocyte Inflammation of hair follicles, for example, Lichen Planopilaris and Pseudopelade, are by and large treated with Corticosteroids in topical creams and by Injections into the affected skin. Likewise, Antimalarial and Isotretinoin Medications might be utilized.

For Scarring Alopecia’s with aggravation of generally Neutrophils or a blend of cells, treatment includes Antibiotics and Isotretinoin. All the more tentatively, drugs like Methotrexate, Tacrolimus, Cyclosporin, and even Thalidomide have been utilized to treat a few structures.

Once a Scarring Alopecia has achieved the burn out stage and there has been no more Hair Loss for a couple of years, Bald areas can be either surgically expelled on the off chance that they are not very huge or the Bald Patches can be transplanted with hair follicles taken from unaffected areas.