Date Archives December 2021

Cancer cervix

Cancer cervix is the second most important cancer in India over the last two decades.

Why must we know these figures? Because Cancer Cervix is rampant and a huge killer.


  • It causes 23.5 % of all cancers in women in India.
    Globally age-adjusted incidence rates are 15.3/100000. In India, this is 27/100000.

  • The incidence has reduced in urban areas but in rural areas, with limited-resource settings in medical treatment, it is still very high.

  • Every year about 134420 cases are added in India and about 75000 deaths occur due to the same. (2008)

  • By 2025 the projected increase in numbers is up to 116171.

 

-Why vaccinate?
We do not know the reasons behind many cancers, however, this is not true about the Cancer cervix. It is caused by a very common virus called HPV or Human Papillomavirus which is sexually transmitted. If we target girls for vaccination before they start with sexual activity , it will protect against this extremely ominous disease.

Which vaccines are available?
There are 2 vaccines available in India.
One is called Gardasil

The other is called CervarixGardasil protects against HPV 6,11,16,18,31,33,45,52,53


Gardasil also protects against genital warts, cancer of the anus, vagina and vulva, and is also licensed for males( though not in India)

Cervarix protects against the two high-risk HPV viruses 16,18


HPV 16 and 18 are the high-risk viruses and cause 66% of cases of cervical cancer. The rest cause around 15 % cases.
Low-risk HPV viruses cause anal and genital warts.

Who is to be vaccinated?
HPV vaccination is indicated for girls between 9-26 years of age. Some clinicians also propose vaccination till 45 years of age.

How many doses are to be given?


  • For girls between 9-14 years, 2 doses are indicated, one at 0 months, the other 6-12 months later.

  • For girls who receive the first dose on their 15 th birthday or later, 3 doses are required, at 0 months,2 months and 6 months.

  • For immunocompromised patients even less than 15 years,3 doses are needed.

Mode of administration?
Intramuscular

What are the side effects of HPV vaccines?
The side effects are minor and cause fever, dizziness, nausea, mild pain in the upper arm at the site of injection.

Are they indicated in pregnancy?
No. However if inadvertently given to a pregnant lady, this is not an indication to terminate the pregnancy.

Some pertinent questions:


If someone in the age group of 9-14 years gets 2 doses but less than 5 months apart do we need to give a third dose?

YES


If someone is more than 15 years of age but vaccination was started at 11 years of age, are 2 doses needed or 3?


1 DOSE as the first dose of vaccination was initiated before the 15 th birthday.


If the vaccination schedule was interrupted do all doses need to be repeated?
NO


Do we still need to screen for cervical cancer?
YES

Zika virus

As the first case of the Zika virus is reported in Delhi at the RML hospital, there’s widespread buzz and panic about the virus and its effects on pregnant women. Let’s attempt to understand more about it. 

Zika virus was first detected in Uganda in 1947 and is transmitted by the bite of the Aedes mosquito ( Aedes aegypti and Aedes albopictus); these mosquitoes are found all over the world especially in tropical and subtropical areas and are both day and night biters. 

Zika virus causes outbreaks in Central, South and North America and also in and around West Africa. Because of increasing globalisation and international travel, it is likely that there may be infections reported in many more regions. 

When the mosquito bites a person infected with the Zika virus, it infects the mosquito, which in turn infects another person with its bite. It enters the person’s bloodstream and causes symptoms of the infection. 

The virus can also be transmitted from an infected person to another by unprotected sexual intercourse. Blood transfusion and organ donation by an infected person are also means of transmission. 

During pregnancy, an infected mother can spread it to the unborn fetus. This is a dangerous form. 

 

Risk factors

Living in areas where infections are rampant increase the chances of Zika virus infection. Moreover, unprotected sex with partners who have lived or travelled recently from endemic areas also run the risk of getting infected. 

 

Symptoms of Zika virus infection

Remember this infection is very mild. In fact, 4 out of 5 people infected are completely asymptomatic. Infections begin 2 days to 2 weeks after the bite of an infected mosquito. Symptoms are similar to dengue and like many viral fevers last about a week. Most people have a mild fever, rash, severe body ache, a feeling of being unwell, joint pains and red eyes or conjunctivitis. 

There is headache, eye pain and maybe accompanying abdominal pain too. Most people recover completely; however, some may have late-onset neurological complications as well as Guillain Barre syndrome even in people who never really had any symptoms of the disease. 

Pregnant girls infected with the virus may have a spontaneous miscarriage, preterm births and stillbirths. 

Congenital Zika syndrome is a serious birth defect in infants born to mothers who were infected during pregnancy. 

These include microcephaly( a much smaller brain and head size) with a partly collapsed skull. There may be brain damage and reduced brain matter, eye damage, hypertonus( too much muscle tone )leading to reduced body movement and joint problems. So as you can see, the virus causes very mild symptoms in the pregnant woman but there are huge ramifications on the unborn baby . 

 

Diagnosis of Zika virus infection 

This can be done by RT PCR using the infected person’s serum, urine and throat samples. If the RNA of the virus is detected, it confirms the infection.

 

Treatment of Zika virus infection

All that is needed is plenty of rest, oral fluids and hydration, paracetamol and over the counter medicines for fever and pain. 

 

Prevention 

Currently, there is no vaccine or antiviral treatment for this virus, so prevention by other means is the best bet. Prevent yourself from mosquito bites.

If you are pregnant or attempting to get pregnant, you must not travel to countries where Zika virus outbreaks are common. You must wait two to three months to try to conceive if you have travelled to these regions. 

Practising safe sex is important; more so if your partner lives in or has travelled to areas where outbreaks are common.

You must protect yourself from mosquito bites by wearing protective clothing like full-sleeved clothes, long trousers, shoes and socks. 

You must use mosquito repellents and if you live in areas that are heavily infested with mosquitoes, you must use a mosquito net as well. 

You must make sure that you destroy mosquito habitats such as stagnant water in coolers, flower pots, containers, used automobile tyres. 

As is the norm with dengue prevention, you must follow a weekly regime of emptying standing water sources in and around your home. Using oil over drains and other areas which harbour these mosquitos also help to reduce their population and hence chances of infection.

Anaemia in Pregnancy

50 per cent of pregnant girls in India suffer from anaemia. 

When you suffer from anaemia, your blood does not have healthy Red blood cells to carry oxygen to your tissues and your baby. Your body uses Iron to make Haemoglobin, the protein that carries oxygen in the RBCs. 

Types of anaemia in pregnancy are Iron deficiency anaemia, Folate deficiency anaemia and Vitamin B 12 anaemia. 

What are the risk factors for anaemia? 

If you’re anaemic before you become pregnant, don’t have an iron-rich diet, are vegan or vegetarian, have twins or multiple order pregnancy, have pregnancies too close together, have severe vomiting in pregnancy, malabsorption syndromes, chronic infections like malaria, TB, worm infestations or conditions like Thalassemia or excessive menstrual loss prior to pregnancy, you are more liable to get anaemia in pregnancy. 

 

What are the symptoms of anaemia? 

Easy fatiguability, weakness, dizziness, palpitations, rapid heartbeat, breathlessness, trouble concentrating, pale lips and nails are common features of anaemia. 

What are the risks to the foetus if you are anaemic? 

There is a greater chance of preterm birth and low birth weight babies. 

You run a risk of post Partum haemorrhage necessitating blood transfusion, your baby may be anaemic as well. 

Untreated folate deficiency may lead to babies with neural tube defects. 

How does your doctor diagnose the same? 

Blood tests like Complete haemogram, Peripheral smear for the type of anaemia, Vitamin B 12 and Folate levels, HPLC tests to rule out Thalassemia, stool tests to detect ova and cysts due to worm infestations are ordered. In the very first antenatal visit itself, your doctor takes your history, does a clinical examination and orders your blood test that can detect anaemia. 

How is anaemia prevented and treated? 

Iron supplements that contain 60-100 mg of elemental iron, Folic acid 500 micrograms and Vitamin C that helps in iron absorption need to be taken. 

Always remember never to take Iron capsules along with Calcium or with antacids as these reduce Iron absorption in the gut. Also taking too much tea and coffee also reduce Iron absorption. 

Taking a diet rich in iron like green leafy vegetables -spinach, methi, sarsoan, kale, broccoli, lean red meat, fish, eggs, poultry, cereals fortified with Folic acid reduces the chances of anaemia. 

A course of deworming medicines also helps in treating anaemia caused due to worm infestations. 

If you are intolerant to oral Iron or suffer from malabsorption you may need parental ( intramuscular or intravenous iron ) 

Sometimes severe anaemia may require blood transfusion as well. 

Let’s do our bit to fight the menace of anaemia. Let’s work towards a brighter pregnancy.

Mastitis

Mastitis is an inflammation of breast tissue that is commonest in breastfeeding girls and may be associated with infection. This inflammation causes redness, wedge-shaped swelling, warmth and breast pain. 

It may cause flu-like symptoms too. Fever, chills and rigors are common. 

Mastitis can also occur in non-lactating women and also in men. 

Sometimes there may be chronic mastitis and occasionally a rare form of cancer called inflammatory cancer may mimic mastitis in older women. Patients with reduced immunity like those who have Diabetes, AIDS, those on steroids and drugs which suppress immunity can have mastitis. 

 

Why does this problem occur? 

A blocked milk duct due to incomplete feeding can cause one of the milk ducts to get clogged. Bacteria entering these ducts due to cracked nipples, mostly from the baby’s mouth can cause the same. Incorrect positioning of the baby while feeding and improper latching can also cause cracks in the nipple. 

In postmenopausal women, there is clogging of the ducts due to cells and debris that can precipitate this infection.

 

What are the risk factors? 

Previous bouts of mastitis when lactating , wearing too tight a bra , improper nursing techniques, poor nutrition , hygiene and smoking are risk factors . 

 

What are the signs and symptoms? 

Pain in the breast, generally on one side, redness, swelling, a breast lump, general malaise or high-grade temperature with chills. 

 

Complications? 

There may be a collection of pus or an abscess that may be caused due to mastitis. This may then require surgical drainage. 

 

What is the solution? 

Most times your doctor can make a diagnosis on physical examination. If there’s pus discharge from the nipple signifying an abscess, it will require a culture of breast milk or nipple discharge. 

Inflammatory Cancer may require an ultrasound of the breasts or mammography. 

 

Treatment 

Antibiotics, painkillers, hot compresses before completely emptying the breast and cold compresses after painful lactation, massaging the breast when feeding or pumping from the affected area towards the nipple are some of the tips in treatment. 

Proper latching techniques and continuing to breastfeed even alongside mastitis helps. Breastfeeding from the affected side first when your baby is hungrier helps to empty the breast due to stronger suckling.

Proper rest and hydration also help. 

Most times it resolves within days to a couple of weeks. If it does not, you must meet your doctor.