CACANCER-DEATH / DISABILTY / DRUG DEPENDANCE ----ARE THEY ASSOCIATED ?HOW TO FIGHT IT?

Cancer ,word it self fetches us to a very frieghtening and fearful meaning,if ,unfortunately somone in our family or society is being suspected or suffering from it and the word "CANCER" comes beore us in any way ,we start presuming very badly and gets completely shocked and nervous assuming that person concerned is very very seroius and his /her days are almost in counting scale and we became wholly sympathetic for that person forgetting every his/her adversary towards us and try to help the person as far as possibly by money,service or any other means if possible.But in real Biological sense "CANCER" is not that kind of Lion or Tiger that once you face it there is no hope of life and certainly it is not curable and we should be completely depressed and hopeless becauuse many "CANCERS" are now completely curable and life becomes as normal as it was without it ,only thing is that it should be detected as early as possible and treatment should be started as soon as possible.It is commonly believed that once Cancer means we,shall be never cured from this ,we have to take medicine regularly throughout the life,and we donot know when recurrence may occur and again mor discomfort or Death may come to us any time,person has to be in screening throughout the life moving to Hospital or doctor almost off and on throughout the life.Yes,for some persons these lines are true but in many cases these are simple myths ,Cancer once cured,never recurs or recur in so less percentage that one has nothing to worry,even follow up of symptoms noticing is important,that is with every disese once one suffers from cold or cough or diarrhoea one goes to Doctor,same way here one has to go to Doctor,no test or investigations are required and life becmes as normal as it was originally without Cancer,so nothing to worry,be happy,never get depressed or shcoked by this word,cancer, never loose heart face it at first meeting boldly and fight so well that finish it nipped into bud.As the modern science is growing and more and more reaseaches are done and treatment bieng enforced to treat Cancer by means of better chemotherapeutics or medicines with very less sideeffects,Monoclonal Antibodies,different caccines,interferons and Stem cell with development of Gene therapy ,better rays inform of Positron euipped with Ct scan and MRI or Tomography machine,Cyber knief,Brain Suits,or IMRT or Brachytherapy, Stereotactic Radiotherapy beside cobalt ,gamma and X-rt with linear acceletor and modern Surgical removl of cancer using ultrasound,ct scan,Laproscope and modern robotic Surgery with the facility of FNAC, TRUCUT BIOPSY,FROZEN BIOPSY and better detectection and control of micro metastases has made much advancement leading to almost curbing and controlling Cancer denovo.

In Medical Biology Cancer is defined "Uncontrolled Growth of Cells." that is if our finger which is shaped like a finger is constituted by Bone,Many MUscles,Tendon,Nerve and Blood and Lymphatic vessels covered by skin with hairs,sweat glnd and many type of receptors of pain,temperature,touch etc, type of tissues and each of these tissues are made up of many cells,like a brick which forms our house.if one or few cells starts dividing rapidly and excess cells are not destroyed ,first the shape of Finger will be destroyed and then whole finger will be deformed and gradually such growth will spread to hand and will deform and dysfunction it too.Normally in our body there is a check and balance of every Growth,excess and unrequired growth is destroyed or designed sothat a proper shape and function of every organ is established.But once this check and balance is destroyed such growth is called "CANCER" or "TUMOR" which may be localised to the organ where it was orginated or spread to adjoining organs or may spred by Lymph or Blood vessels to differnet distanorgan as cancer of leg spreading to Brain,Liver,Lung etc. and vice versa.if locally organised Tumor these are called "BENIGN CANCER OR GOOD TUMORS' as once excised they are mostly completely curable with use of Surgery or radiotherapy BUT THOSE TUMORS WHICH SPREAD FROM ORIGINATIONG ORGAN TO OTHER ORGANS ARE CALLED "metastatic tumors or bad tumors or growth" as they are once removed from a local place by radio or Surery may recur immediately or after months or years from distant place ,so they are taken care of by using Chemotherapy or Cancer Drugs which also kills normal cell too,so are some time very toxic killing Blood,Hairs,skin and many growing cells bringing so many side effects,some time so much that we have to stop these medicines as patient cannot bear them physically and economically resulting into icreased morbidity and mortality.Newer added Medicines like Interferons,Monoclonal Antibodies,Genetherapy,Stem cells and modern cancer drugs are very very costly being out of reach from many Patients of Developing countries.

Human body is made up of 60 trillion cells and different type of Tissues which after combinig form differnt organs and Organs form the Body .Till date if these Organs are working synchronically or working in order from each organ to another organ ,Life exists as their chronological or systemic or disciplined working toghther is hampered or this cycle is stopped by any meber organ of cycle ,all organs stars failig one after another and we say Death occured,we donot know which is starting point and which is end point,some say Brain,Some Say Heart but in real sense it is their working togher with each other mattrers,no one is superior,no one is inferior. Most of the cells except the cells in the brain re-live by the process of division and replacement. It can be simply understood that after a given time the old cell is replaced by new cell, exact replica of its predecessor. The renewal of the cells after a given time is a natural process but uncontrolled growth of cells is not natural.Even some cells grow abnormally ,to start with these are killed by Body Immunity as checking mechanism but if growth is excessive or Immunity is not reacting ,these became permanent and called Cancer.This is the reason that cancer is not recognised as an abnormal activity by the immune system of the body and therefore, cancer detection is very difficult unless it affects the performance of an organ or organs,symptoms or signs are attributed to the organ concerned if Eye means loss of vission,if Larynx means loss of voice etc.,but Cancer in itself does not have any symptoms. The first question which comes to anyone's mind is –If it is not a natural process then why does a cell start uncontrolled growth? The exact answer for this question is not yet known to humanity. The answer to this question lies in identifying the part of the cell, which is responsible for initiating the process of self replication and excessive reproduction. Presumably, it may be some section in the DNA, cell membrane or may be anything else either being stimulated by some external things like sunlight in cancer of skin Melanoma or heat,or application of some chemicals used locally or ingested inside but many times cause is not exactly known,some cancer runs in family and strong genetic basis is present for every Cancer either coming as sporidally mutation of gene in an Individual or by hereditary in family.Here lies the success of stem therapy or gene Modulation or therapy to treat cancer.

Surgery is the basic of treating most cancers of Abdominal organs,Hand,leg or extremities,lung,brain,breast and chest wall ,skin etc but surgery completely cannot remove the whole tumor as tumor might have spread to important organ completely as to Liver or pancreas ,we cannot completely remove these organs so after a good chunk removal we use radiotherapy to remove these cells or we can use radiotherapy initially to control thest tumors and then can resect them once their size is less or can use with surgery or after it to rmove any remaining tumor unvisiblt that time or because of important organ not removed in first chance.Some time for mouth ,tongue,cervix,breast cancer we use Raditherapy to burn these tumor in first instance and donot use surgery at all but may use surgey if tumor remains after 8-10 wks of radiotherapy or if tumor recurs at this site .Similiarly for cancer of Blood and connective tissue crmotherapy or Medicines are only needed no sugery or Raditherapy is needed,some time to make tumor resectable we use cheotherapy first but mostly we use it after surgery or radiotherapy to remove tumor completely from originationg sit and then removing any micro spread which occured to ant distant organ either dtectable or undeteable in first phase or recurrence phase.

Overall the subject is very vast and many reasearches are going on making Human life more safe and precious ,the days will come soon when Man will win over this demon completely and even today our victory should not be ubderestimated because we can completely overcome Cancer if it is detected and treated in early stage by present modern gadgets of Surgery,Chemotherapy and radiotherapy,many Ayush and otherwise natural healers and therapist claim many medicnes to cure them completely by showing or claiming their personal cases and experiences,in this regard this is advisable that please expose first your claim internationally by publishing papers in good modern Journals of modern Medicines or of your subject or therapy,simple assertions and personal claim may not be hold good for many other patients as aberrations are known in medical science so,please refer the patient to good medicl college or centre when you see any cancer patient,donot keep patient in your clutch only,allow them to get detected the Disease or cancer completely and then get started the therapy ,with this therapy you may add your medicines too if you are very confident or qualified otherwise for earning money if some false promises or trials are done on some patients of villages or slum or from poor uneducated class of our country by so many self claimed healers or doctors using any therapy is a heinous crime on the earth and please restrain from this and help the society to curb this fatal disease completely and in first instance.

Dr.d.r.Nakipuria

Ambika chikitshalya

29 agrasen road

siliguri-734005

Recently just published Article in a prestigious and reputed Jounal of World fame "LANCET" by an Indian scientist on presence of NDM-1 Bacteria,originating from New Delhi, Called New Delhi Metallo-beta-Lactamase-1,a new Superbug ,is really a new threat to World and our country too.But the way it has been published with an inference at last paragraph issuing a warning to all coutries and persons of World to be ware of going to India as if it is only hub and concentrated centre of this newly discovered Gram Negative Bactria or called BUG and adding name of our capital "NEW DELHI" to its name only on the basis of one patient who got treatment from New Delhi before detection of this Bacteria from his blood in Sudan,having no knowledge whether he was carrying it before treatment in India and then sporidacally adding that it is also found in Pakistan,Bangladesh and even in UK raise seroius question regarding authencity of such publication funded by two multi national Drug companies who make medicines ,Antibiotics for killing Bacterias and secondly by maligning India to prevent Foregners coming to INDIA for Treatment leaving UK and European and America .This bacteria like all bacteria might be prevalet in all parts of World but as no research has been done carefully to identify it in various part of World cannot be accepted as it is found mainly in New Delhi /India/Pakistan/Bangladesh only.
If Journal like Lancet is also manipulated like this then our whole Humanity is under threat ,any body can get any thing published to control or manipulate any thing to market or defame any product but once it is coming to world of Health it is a really serious question for humanity as corruption,manipulation favourism or criticism like such will spoil our Human Enviornment of turst and belief completely.
Therefore ,it is not only limited to Our Politicians,Health Ministry Parliament,ICMR,Medical Associations and Doctors of India but of whole World should protest against it in India and whole world ,serois objection should be stated at WHO level as why such reports were published in this manner to malign the name of a country to check "MEDICAL TOURISM" and such efforts should be nipped in the bud today and even in future sothat Commerce and Market should atleast spare Health System for giving wrong informations otherwise whole Humanity will collapse.
But it does not mean that we shall not take precautions,we should take extra effort in sterilisation of our Operation Theatre,Post up Wards and Preop Wards and post Op care somuch clean and clear that such Bacteria never infect any patient whether Indian or from outside under our treatment.
we know that Bactrias are known for mutations to save its progeny from devastation by bringing change in ts plamid and cell wall proteins. esearchers and is resistant to all known antibiotics. These are not being killed by modern Carbopenams(meropenam)and other Beta Lactamase Inhibitors(Tazobactum,sulbactum,pipercillin) as a result more infection to wounds will come to a normal patients in our hospital and those compromised like diabetics,suffering from cancer,HIV,getting,immunosupressants for transplants, immunological disorders,on steroid,cancer chemotherapy,elderly and childrens.

Lancet Infectious disease journal reports 50 such cases. Most of them have carried this infection from India, Pakistan and Bangladesh. The superbug NDM-1 is named after the national capital, where a Swedish patient was reportedly infected after undergoing a surgery in 2008. It is much more dangerous than the notorious MRSA infection.
MDM-1 is an enzyme produced by certain bacteria, which allows them to neutralize the harmful effects of carbapenem one of the most powerful types of antibiotics. Currently no new types of antibiotics are in the development pipeline that will be effective against it. Enzymes such MDM-1 are produced by strands of DNA which bacteria are known to transfer between one another. Currently E Coli and Klebsiella Pneumoniae are the two bacteria who are host to MDM-1. What makes the superbug more dangerous is its ability to jump across different bacterial species. The superbug has the potential to get copied and transferred between bacteria, allowing it to spread rapidly. If it spreads to an already hard-to-treat bacterial infection, it can turn more dangerous.The current treatment option is to treat them with a cocktail of antibiotics. Most new antibiotics currently under development are effective only against gram positive bacteria like super bug MRSA. Unfortunately, bacteria that carry the NDM-1 enzymes are gram negative.

A joint study was led by Chennai-based Karthikeyan Kumarasamy, pursuing his PhD at University of Madras and UK-based Timothy Walsh from department of immunity, infection and biochemistry, department of medicine, Cardiff University. They found the bug in most of the hospitals in Chennai and Haryana with estimated prevalence of this infection 1.5%. They reported the superbug in 44 patients in Chennai, 26 in Haryana, 37 in the UK and 73 in other places across India, Pakistan and Bangaladesh.gram negative sepsis with culture report: resistant to all antibiotics. We have been seeing such cases in the last few years. Now we have a name for this disease. Many of the doctors are deying its existance and linking it to a move against medical tourism in India. But the ICMR, NICD should work on it and come out with guidelines for this infection as no one can deny the fact that we do see cases of gram negative sepsis with E Coli or Klebsiella with culture report resistant to all antibiotics.

Carbapenemases are carbapenem-hydrolyzing beta-lactamases that confer carbapenem resistance.while Class B enzymes require the presence of zinc for activity (and hence are referred to as metallo-beta-lactamases).Class B beta-lactamases: are also known as the metallo-beta-lactamases (MBLs), which are named for their dependence upon zinc for efficient hydrolysis of beta-lactams. As a result, MBLs can be inhibited by EDTA (an ion chelator), although they cannot be inhibited by beta-lactamase inhibitors such as tazobactam, clavulanate, and sulbactam.
Acquired MBLs consist of genes encoded on integrons residing on large plasmids that are transferable between both species and genera.In a hospital outbreak involving 62 patients (including 40 intensive care unit patients), for example, an MBL gene (bla IMP-4) spread among seven different gram-negative genera (Serratia, Klebsiella, Pseudomonas, Escherichia, Acinetobacter, Citrobacter, and Enterobacter).Laboratory detection of MBL-producing organisms can be especially difficult if the organisms carry "hidden" MBL genes; The MBL E-test (a commercially available assay) cannot consistently identify MBL-producing organisms that are truly resistant to carbapenems. Therefore, MBL-producing organisms should be considered carbapenem-resistant regardless of carbapenem susceptibility results.

Other identification methods take advantage of the zinc dependence of MBLs by using EDTA, which chelates the zinc. Combination disc tests using imipenem and EDTA discs or using two carbapenem discs (including one with EDTA incorporated) have been reported. A more sensitive MBL detection method uses an agar plate with three components: a double disc synergy test with imipenem and EDTA discs, a combined disc test comprising two imipenem discs (with one disc also containing EDTA), and an aztreonam disc to detect aztreonam susceptibility. Carbapenem susceptible isolates that are resistant to both ceftazidime and ticarcillin-clavulanate should be considered for MBL testin Genotypic identification using PCR amplification with primers specific for MBL genes (eg, blaVIM or blaIMP) is an accurate method for the detection of MBL-producing organisms.(Source uptodate)

Therfore,we are not against its finding but its conclusion and attribution to one country India ,more and more reseaches and studies are needed to confirm its real presence in World and how it comes and persist and before doing enough studies such publication with infernces in reputed journals should be avoided otherwise whole Humanity will be at stake and Market and commerce will win over our Human Value.
Dr.d.R.nakipuria
Teacher In North Bengal Medical College for undergarduate and Post Graduate
Ambika Multispeciality Hospital
29 Agrasen roadSiliguri-734005