Category: Uncategorized

41-year-old Piara Begum, a resident of Bhola. She was suffering from a tumour, situated in her uterus, for 9 years. It was initially small in size, so she did not consider it a major problem; but slowly the tumour started to grow in size, increasing her problems. At one point, her condition worsened and abnormal bleeding started. When Piara Begum did not receive any solutions from her local doctor in Bhola, she was moved to Evercare Hospital in Dhaka.

Her treatment started under Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka. Diagnoses revealed that Piara Begum had endometrial polyps in her uterus, due to which she was bleeding continuously. Anaemia was also diagnosed due to this bleeding. This was temporarily solved by supplying her with two bags of blood. Dr. Monowara Begum decided to remove the patient’s tumour through an immediate laparoscopic hysterectomy.

Piara Begum’s tumour removal was successful. Dr. Monowara Begum sent the patient’s removed tumour for a biopsy. As everything had been done properly, and there were no complications after the surgery after one day of observation, the patient was discharged.

A few days later, when Dr. Monowara Begum received the patient’s biopsy report, she found that the tumour had turned into cancer because it had been in the patient’s body for such a long time. Piara Begum’s grade-3 stage-2 endometrioid cancer had infected more than 50% of her uterus. So, to save the patient at this stage, the doctor decided to perform lymphadenectomy again through laparoscopy and then radiotherapy.

The patient underwent lymphadenectomy followed by the removal of her ovaries along with the affected part of the pelvic lymph nodes, and radiotherapy for further treatment of the cancer. For this purpose, Piara Begum was taken to the operation table for the second time and was operated on successfully.

Laparoscopic surgery is now well known to everyone. Today many surgeries are done this way. Surgery through laparoscopy is less painful as minimal or small cuts are made in the patient’s body and the wound heals faster. Therefore, the patient does not require any long post-operative observation. The patient can soon return to a normal life.

Although laparoscopy is used to treat cancer surgery in foreign countries, it was not common in Bangladesh until now. Recently, cancer surgery is being carried out through laparoscopy in Evercare Hospital Dhaka. If the patient’s cancer is in the early stage, then it is possible to treat it with this method of surgery. Evercare Hospital Dhaka is always ready to provide better and more effective treatments to patients through new technologies.

Due to the skillful hands of Dr. Monowara Begum, Senior Consultant and Coordinator of the Department of Obstetrics and Gynaecology at Evercare Hospital Dhaka, Bhola resident Piara Begum is now clear of danger. After two such major surgeries, the patient had no complications and is slowly recovering. She also expressed her gratitude for the sincere support she received from everyone after being admitted to Evercare Hospital Dhaka.

Radiotherapy or radiation therapy is the use of high-energy X-rays, protons, or other particles to eliminate cancer cells. Fast-growing cells such as cancer cells are more sensitive to the effects of radiation therapy than normal cells.

Breast cancer can be treated through radiation therapy in different ways

• EBRT — External Beam Radiotherapy or external radiation:

A device delivers radiation from outside the patient’s body to the breast. This is the most common type of radiation therapy used for breast cancer.

• Internal Radiotherapy or internal radiation (brachytherapy):

An object that delivers temporary radiation to the patient’s breast is placed in the place where the cancer was, after surgery to remove the cancer.

Radiation therapy can be used to treat breast cancer at almost every stage. Radiation therapy is an effective way to reduce the risk of breast cancer recurrence after surgery. Additionally, it is also commonly used to ease symptoms caused by cancer that has spread to other parts of the body (metastatic breast cancer).

Radiation after Lumpectomy:

If there is any breast tissue left after breast cancer surgery, it is called a Lumpectomy or Breast Conservation Surgery or Breast-conserving. After this surgery, radiation is recommended to eliminate the cancer cells. Adding radiation after a lumpectomy greatly reduces the risk of cancer returning to the affected breast. Lumpectomy combined with radiation therapy is often referred to as Breast Conservative Therapy. This type of treatment is just as effective as the removal of all breast tissue or a mastectomy.

Radiation after mastectomy:

Radiation may also be used after mastectomy. In this case, the decision is made based on the patient’s pre-operative cancer status and the post-mastectomy biopsy report.

In the past, radiation therapy or radiotherapy was given for a long time – for almost 5 to 6 weeks, but now there are also options for giving radiotherapy for 3 weeks or even just 1 week.

If the breast cancer has spread to other parts of the body, which we call metastasis, radiation therapy may be recommended to help reduce the cancer and control symptoms such as pain.

Side effects from radiation therapy can manifest in a variety of ways depending on the type of treatment and which tissues are being irradiated. Side effects are usually most noticeable from the third week or towards the end of radiation treatment. Some side effects of radiation treatment for breast cancer are:

• Mild to moderate fatigue
• Skin irritation, such as itching, redness, peeling or blistering
• Swelling of the breast
• Swelling of the arm (lymphedema) etc. if the lymph nodes under the arm are treated.

However, most of the side effects go away or subside after a few days, and advanced treatments are likely to reduce the side effects.

The Role of the Radiation Oncologist

A radiation oncologist is a doctor who specializes in treating cancer with radiation. The radiation oncologist prescribes the appropriate therapy for the patient, monitors the progress of the treatment and provides necessary treatment for side effects if necessary. Radiation oncology medical physicists and dosimetrists also perform calculations and measurements related to radiation dose and delivery.

The Role of the Radiation Technologist

A radiation technologist administers treatment to a patient using a radiation therapy machine. A radiation oncology nurse or physician’s assistant answers questions about treatments and side effects and helps manage the patient’s health during treatment. Therefore, it is “teamwork” and with the participation of all the people mentioned above, radiation therapy is successfully completed.

How Tumor Boards Work

Currently in our country, many hospitals organize tumour boards before starting any cancer treatment. A tumour board is a very important topic in cancer treatment. This is because a tumour board includes an operation doctor, a radiotherapy doctor, a medical oncologist i.e. chemotherapy doctor, a histopathologist i.e. who reports on biopsies, a radiologist i.e. who reports CT scan-MRI and other members.

Their objective is to prescribe an international standard treatment pathway for the patient. After that, according to the advice of the doctors on the tumour board, neoadjuvant therapy is sometimes used to reduce the size of the tumour during the treatment of breast cancer and then proceed to surgery. In many cases the operation is done before everything else. Sometimes treatment is started through Hormone Therapy Treatment.

Evercare Hospital Dhaka: A Leader in Cancer Care

However, before starting treatment with Hormone Therapy, it is necessary to know the status of hormone receptors by immunohistochemistry along with a biopsy. This is how a patient is treated for cancer through surgery, chemotherapy, radiotherapy, hormone therapy and sometimes immunotherapy. Due to unprecedented advancements in medical science, now our country has all kinds of treatment options for breast cancer patients. Evercare Hospital Dhaka always provides better and more effective treatments to patients through new technologies.

 

Dr. Arman Reza Chowdhury

Cancer specialist

Consultant – Department of Radiation Oncology

Evercare Hospital Dhaka.

The Dangers of Dehydration in Summer

The weather in Bangladesh is always hot during the month of April and May. However, this year, the heat is extremely high. Due to the intensity of summer heat, many suffer from dehydration, which is not a good sign for the body. Dry throat, urination problems, tiredness, constipation, weakness, nausea, headache, and dry skin are some of the major symptoms of dehydration. Besides, dehydration negatively affects many organs like kidneys, brain, liver, stomach, and lungs.

How to Stay Hydrated During Summer

Water is one of the essential parts of life, which stands second only after oxygen in terms of body requirements. Experts advise drinking at least 2.7 liters or 8-10 glasses of water per day. Drinking enough water helps us to maintain a proper balance of electrolytes in the body. Our bodies are relatively more active when we go outside.

This is why we lose a lot of water as sweat from our bodies when we go out in hot and humid weather conditions. Dehydration occurs when the body sweats continuously, thus leading to a decrease in water and salt levels from the body. The best way to know whether your body really is hydrated is to observe the color of your urine. If the color of urine is yellow, then your body is dehydrated. In this case, drinking water after frequent intervals is necessary.

The Importance of Drinking Water

We should drink water even before we feel thirsty. This is because of the fact that we feel thirst only after our body has already lost about 2 cups of water. When the body is dehydrated, the cells send a signal to the hypothalamus, which releases a hormone called vasopressin. Moreover, the body needs fluids to make blood as well. When the body lacks water, the blood volume decreases. As a result of this, problems such as low blood pressure, weakness, etc. may occur.

The Effects of Dehydration on the Body

To prevent dehydration, we should avoid soft drinks, tea and coffee as much as possible. This is because ingredients such sugar and sodium which are present in such drinks absorb water from body tissues. To properly hydrate ourselves, we should choose food items that are able to fulfill the water shortage in our bodies.

Vegetables such as cucumber, tomato, cabbage, cauliflower, lettuce and fruits such as sugarcane, watermelon, coconut water, strawberry, apple, orange, /malta etc. are very effective in filling up water deficiency in the body. Additionally, juices from various fruits also help to keep us hydrated.

The lungs play a major role in managing respiration in all living organisms. The main function of the lungs is to take oxygen from the air into the bloodstream and remove carbon dioxide from the bloodstream into the air. Therefore, it is very necessary to make a specific and structured plan to protect the lungs. In order to implement such a plan, World Lung Day is celebrated on 25th September every year around the world.

Currently, we are facing the Covid-19 pandemic caused by SARS-COV-2. Its main target is our lungs. So now we need to take even better care of our lungs.

On World Lung Day, let us come together and say out loud, “Care for your lungs and keep them healthy”. There are various themes for World Lung Day.

‘Say no to tobacco, create a smoke-free environment’

Smoking is the major cause of lung diseases. Around 80 lakh (8 million) people die worldwide every year due to smoking. As a result of COPD lung disease, the patient slowly becomes weaker. If infected with this disease, the patient’s respiratory system will eventually become impaired and death will slowly become imminent. Smokers are also victims of deadly cancer.

Many people can avoid this risk by quitting smoking; within 20 minutes of quitting smoking, the heart rate starts to normalize. The amount of carbon monoxide in the blood decreases within 12 hours. Within 2-12 weeks, the blood circulation and lung functions become more active.

Within 1-9 months the tendency of cough/ dyspnoea starts to decrease. Within 5-15 years the risk of stroke drops to that of a non-smoker. Within 10 years, lung cancer rates are reduced to half. And within 15 years, the risk of heart disease is reduced to that of non-smokers. In addition, ‘e-cigarettes’ should also be avoided.

Regular and timely vaccination

Different viruses such as influenza or bacteria are responsible for pneumococcal pneumonia. To stay safe from such viruses and ensure that our lungs are protected, it is necessary to get flurix/influenza vaccine once a year and a pneumococcal vaccine once every five years. Vaccines protect our lungs from bacterial and viral diseases, boost the body’s immune system and play a huge role in preventing diseases by creating memory cells.

Currently, our respiratory system is under serious threat due to the coronavirus. In addition to this, it causes serious complications like ARDS from pneumonia. Among such patients, 2% face death in the ICU. Therefore, the vaccine plays one of the main roles in keeping the lungs active and safe from frequent bacterial and viral diseases. So we all need to be aware of this.

Fresh air intake

Around 7 million people worldwide are exposed to air pollution every year. According to research by WHO, 9 out of 10 people are consuming polluted air. This polluted air can easily make people sick through the lungs. Additionally smoking, and smoke emitted from wood-burning stoves in rural areas are causing women to suffer from a deadly disease called COPD.

Apart from this, smoke emitted from factories, brick kilns, cars etc. is also one of the main causes of this disease. Disease levels are high in places where air pollution levels are high. So, it is necessary to know the level of air pollution around your home.

Regular exercise and lung exercises

One of the conditions for keeping the body active and healthy is to keep the main organs of the body (e.g. the lungs, heart and kidneys) active. We can maintain normal levels of oxygen in the body by exercising regularly, getting physical activity and by intake of fresh air. A small machine called a Mini Pulse Oximeter is now available for measuring SPO and heart rate, which is very affordable and useful.

If we want to, we can actively participate in the combined efforts to protect lung health worldwide. To live healthily we need to be more aware. The right amount of knowledge about health and its proper applications can ensure good health. It can also make life more peaceful.

May this be our mantra on World Health Day

Take in clean air and quit smoking

and get timely vaccinations

to protect your lungs and promote good health.

 

Professor Dr. Rowshne Jahan

MBBS (DMCH), DTCD (DU), MD (Chest)

Senior Consultant and Coordinator- Respiratory Medicine

Evercare Hospital Dhaka

 

One morning after your child suddenly wakes up, their eyes and face seem swollen. You think they might have overslept, but within a few days, it starts to continuously increase. You then think they might have an allergy, or a problem with their eyes. In the meantime, you also notice that they are urinating only 1-2 times day, and in very little quantity. Their legs and stomach also seem swollen.

Now you’re worried, and you rush to your child’s doctor. He quickly conducts some urine and bloods tests to reveal that your baby has a kidney disease called ‘Nephrotic Syndrome’. Your child’s treatment then begins – they are monitored, their daily urine levels checked, and fluid intake adjusted as per urine volume; and in the initial stage the mother is asked to admit their child to the hospital and kept informed about treatment.

The family is now in shock. Such a small child to be suffering from kidney disease! Will their kidneys fail and stop working? Are both kidneys affected? What food should they be given, what should they not be given, and various other questions were brought up by the parents.

So now we know why Nephrotic Syndrome happens, who is likely to get infected by it, what is the treatment, whether the kidney is damaged, what medicines are used and what are their side effects are.

Who suffers from nephrotic syndrome and why does it happen?

Let’s talk about Nephrotic Syndrome in our children. In most cases, it usually occurs in children from the age of 2 to 6/8 years. The rate of Nephrotic Syndrome is slightly higher in male children. No direct cause of the primary nephrotic syndrome is known, however, there are various theoretical explanations. For whatever reason, the kidney membrane cannot temporarily retain the body’s non-proteinaceous substances or albumin, and it is excreted in the urine, resulting in a lack of albumin in the blood vessels.

Albumin mainly helps to retain water in the human body. So, when it is deficient, water from the blood accumulates inside different parts of the body and water inflates the child’s eyes, mouth, stomach, and feet.

What kind of symptoms do the children show?

Swelling of various parts of the body such as the eyes, face, and feet; decreased urine output; abdominal pain, urinary tract infections and pneumonia may accompany this as the immune system is weak during this time.

How is this disease diagnosed?

Your child’s doctor will do more tests to check the amount of albumin in the urine and blood and to see if there are any other complications.

Treatment method:

Primary treatment starts with steroid drugs as well as the treatment of other complications or infections. Treatment is primarily long-term and will continue in two 6-week sessions for a total of 12 weeks.
Steroids or prednisolone are considered the lifelines of this disease. In most cases, the flow of protein in the urine stops within 14 days of consuming the drug. If the flow of protein does not stop within 30 days, it is called Acute Nephrotic Syndrome. In that case, other tests are needed, including a kidney biopsy, and other drugs are needed in addition to steroids.

Does nephrotic syndrome get better if treated at once?

Most (90%) cases of Nephrotic Syndrome get better with treatment, and the good news is that in most cases there is no damage to kidney functions. However, the downside is that the disease is likely to recur in 60-80% of cases.

Are there any side effects of the treatment?

Yes, there are. As the disease is treated with steroids, it has several side effects, such as swelling of the cheeks and abdomen which is not due to water, increased appetite, acidity, behavioural changes in the child and increased blood pressure in some cases.

How to take care of the child/What food to give the child:

•During this period, as the immune system is weakened due to both illness and medication, the child should be kept safe at home. Contact with patients who have illnesses, especially measles and chicken pox should be avoided, and these patients should be kept away from the child.
• A doctor must be consulted before taking the vaccine.
• In the case of food, eat more non-vegetarian foods, such as egg whites. Excess oily food including egg yolks should be avoided.
• Foods with excess salt and salt should not be eaten separately.
• When the child urinates less, the amount of water or liquid food should be reduced. When they urinate more, increase the amount again.
• You must learn how to do a Urine Albumin test at home, which can be determined by strip or burning it, and the child should be tested at least three days a week, even in healthy conditions, and especially when they are suffering from fever, cold or cough-related illness. If the albumin level is 2+ or more for three consecutive days, a doctor should be consulted.
• Since the fever, cold and cough of these children can sometimes reach a severe level, complications are reduced if proper treatment is taken without delay.
• It is also important for the children to take special vaccinations. These vaccinations should be taken in healthy conditions as per the doctor’s advice.

Expert Nephrology Consultants at Evercare Hospital

Evercare Hospital is one of the best private hospitals in the country that have advanced medical equipment and modern medical systems in their Nephrology department. They have expert Nephrology Consultant, junior doctors, nurses, and technicians who are highly experienced in-patient care and are treating hundreds of patients with kidney disease.

Your child’s good health is all we desire

Where Bangladesh is concerned, cervical cancer and its treatment are very important; cervical cancer ranks highest after breast cancer for Bangladeshi women. This cancer is a burden for Bangladesh due to a lack of screening, child marriages, sexually transmitted diseases and low socioeconomic status.

However, due to the unprecedented advancement of medical science in this country, Evercare Hospital has made great progress in the diagnosis and treatment of cervical cancer. It is now possible for patients in our country to receive world-class medical care for almost all cancers, including cervical cancer.

Radiotherapy is a very important treatment method for cervical cancer. Surgery or radiotherapy have similar results, especially in cases of early-stage cervical cancer. However, if the cancer has progressed, chemotherapy can be added to radiotherapy to make the treatment even more effective, giving better results.

Recently, thanks to new methods such as ‘abdominal CT scan’ or ‘MRI scan’ which help to understand the stage of the cancer, it is possible to treat it more accurately with modern radiotherapy.

Role of Abdominal CT Scan in Radiotherapy Planning:

If cervical cancer has spread to lymph nodes around the uterus, it is considered a bad stage of the disease. In all these patients, if the lymph nodes are not properly treated, the chances of disease recurrence increase. Abdominal CT scan is more helpful in finding these types of lymph nodes than CT scan or MRI. In that case, before starting the treatment, CT scan of the abdomen can provide a clear idea about the stage of the cancer and the radiation oncologist can make the right decision regarding the treatment of the patient.

If there is a metastasis in a lymph node, from taking the area along with the nearby lymph node station to giving a higher dose boost to the diseased lymph node with the SIB technique – all are possible with modern radiation such as IMRT. through therapy.

Also, many times through abdominal CT scan it can be diagnosed if cervical cancer has spread to other distant parts of the body and in that case the treatment plan changes to a large extent.

Role of MRI in Radiotherapy Planning:

Cervical cancer staging and radiotherapy planning are based on clinical data. Local extension of the tumour, especially its size, whether the parametrium is involved, and whether it has invaded the pelvic side wall, are often difficult to determine by clinical examination alone.

In such cases, MRI is very important, as it gives a good idea of how far the tumour has spread and how much the disease has been reduced by treatment. After pelvic radiation, it is possible to obtain a clearer picture of residual tumours with MRI than with both CT scan and clinical examination under anaesthesia.

In addition, MRI-based brachytherapy allows higher doses of radiation to be delivered to tumours than in conventional brachytherapy, while also protecting radiosensitive organs such as the rectum and bladder.

Many patients are treated with a technique called intensity modulated radiation therapy (IMRT). IMRT is a type of three-dimensional radiation that safely and painlessly delivers a precise radiation dose to a tumour, while greatly reducing the dose to the surrounding normal tissue.

This usually requires 4 to 6 weeks of treatment. It is hoped that the above-mentioned procedures, from abdominal CT scans and MRI to advanced radiotherapy such as 3D CRT, IMRT are now available in Bangladesh.

Dr. Arman Reza Chowdhury
Consultant, – Department of Radiation Oncology
Evercare Hospital, Dhaka.