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The number of cancer survivors has increased tremendously over the past three decades with improvements in healthcare to detect and provide therapeutic treatment. As per international statistics, with current treatment techniques, almost two out of three cancers are curable. However, being cured is often not the end of the road for most cancer survivors. The goals of cancer survivorship care include promoting physical and emotional well-being, reducing the risk of late effects, and providing ongoing monitoring for the potential recurrence of cancer or the occurrence of secondary cancers.

Dr Kakoli Lahkar, Consultant - Medical Oncology. Manipal Hospital Old Airport Road believes that due to a lack of awareness and education and widespread societal stigma, women often avoid seeking medical care until it is much too late, losing their lives to a highly preventable and curable form of cancer. According to Globocan 2020, cervical cancer has over 1 lakh new cases reported yearly. It is the fourth most prevalent cancer in women worldwide, with 85% of occurrences happening in developing nations such as India, where rural women are more likely to be impacted.

Risk Factors

Dr Kakoli Lahkar shares, ‘unlike other malignancies, we know that the persistent presence of the human papillomavirus (HPV) is the primary cause of cervical cancer, particularly in high-prevalence developing nations. As HPV is a virus that is transmitted through sexual contact, a lack of cleanliness, early marriage and delivery, several sexual partners (especially when the sex is unprotected), repeated childbirths, and smoking. the presence of sexually transmitted diseases (STDs), and persistent immunosuppression owing to infections such as HIV are all risk factors for cervical cancer”.

The champions of robot-assisted surgery (RAS), the top surgeons from all over India, discuss why and how RAS will witness revolutionary growth very soon.

The healthcare sector has seen many developments and innovations in the digital healthcare space worldwide. The innovations span across the spectrum including new drug discovery, drug delivery methods, packaging and distribution, diagnostics, and treatment methods. One of the disruptive tech-led innovations of the 21st century has been assistive robotic technology for surgeries. Due to its rising popularity, minimally invasive surgeries are today almost becoming synonymous with robot-assisted surgeries in India’s top metropolitan centres.

The robot-assisted surgery (RAS) helps operating doctors perform surgical procedures with precision, flexibility, and control. With chronic and infectious diseases on the rise, higher disposable incomes, and growing patient demand for minimally invasive surgeries, robot-assisted surgeries are on the rise.

RAS also offers greater precision than traditional surgeries due to the use of higher levels of magnification provided by the cameras. Explains Dr. Deepak Dubey, the HOD and Consultant – Urology, Robotic Surgery, and Renal Transplantation, Manipal Hospital, Old Airport Road, Bengaluru, “A human eye cannot get a magnified view of the tissue, unlike in the case of robotic surgery. Especially in the case of obese, heavily built patients, this would affect the level of precision during the surgery. The robotic camera gives a ten-times magnified view of the area to be operated on. As the operating surgeon gets a detailed vision of the internal anatomy of the kidney, it lends precision to the procedure.”

A combination of genetics, environmental triggers, and the immune system can cause parts of the intestine i kids to get inflamed leading to IBD that lasts a long time.

Inflammatory Bowel Disease (IBD) is a chronic ailment of the intestine. It can occur both, in adults and children. Nearly 25% of all patients with IBD fall in the paediatric age group. It is associated with prolonged inflammation of the digestive or gastrointestinal (GI) tract, affecting one or both the intestines together. In this condition, the body’s immune system starts attacking the intestinal tissue and causes ulcers, swelling, inflammation, and other issues. A few decades ago, IBD was a very rare condition. However, there has been an increase in the incidence of IBD since the Covid-19 pandemic. While only about one case of IBD per year used to be reported earlier, now doctors are witnessing one to two cases in the paediatric age group every month.

As IBD is an auto-immune disorder where the immune system damages the intestine, the body’s immunity goes haywire, and the immune system starts attacking the intestine. Along with immunity, it may also be driven by multiple factors, such as genetics, environmental factors (modern diet and lifestyle), nutritional deficiency, and changes in the gut microbiome.

Prevention

Since this condition originated during industrialisation in western Europe, it is believed to be heavily influenced by modern lifestyles and eating habits, especially the increased consumption of processed foods. Thus, avoiding processed foods and opting for a healthy diet rich in nutrients can help lower the risk of IBD in children. In addition, leading a physically-active life is necessary to keep oneself healthy and away from not only IBD but also other diseases. Even though there is no permanent cure for IBD, children can still live a life of good quality by being aware of all aspects of preventing IBD and following the doctor’s recommended treatment plan.

(The author is a consultant in paediatric gastroenterology & hepatology.)

A 34 year old Suma (name changed), diagnosed with Homozygous Familial Hypercholesterolemia (HoFH) since 2014 was referred to Manipal Hospital, Old Airport Road, Bengaluru. HoFH is a condition where two abnormal genes one from each parent is inherited by the patient. This leads to very high levels of bad cholesterol which deposits in the blood vessels leading to heart disease and premature death. Our patient too developed cardiac symptoms and was referred to Dr. Devananda N S, Head & Consultant – Cardiothoracic Vascular Surgery and Lung Transplant Surgery, Manipal Hospital Old Airport Road, Bengaluru for bypass surgery of the heart in 2021.

Following the surgery she was referred to Dr. WG CDR S.S. Iyengar, Consultant - Cardiologist, Manipal Hospital Old Airport Road for further management and was treated with statins and lipid lowering agents. She had suffered a miscarriage at 7-8 weeks gestation during her first pregnancy in 2018. She conceived again for the second time in early 2022. In view of the high risk pregnancy, the lack of efficacy and inability to use some drugs in pregnancy, lipoprotein apheresis procedure was considered by Dr. S.S. Iyengar and the patient referred to Transfusion Medicine department.

5-year-old undergoes rare, complex heart surgery at Manipal

Saeed Mohammad, a 5-year-old boy from Yemen, was suffering from tiredness and blue discoloration of the skin for over a year. When his family consulted a doctor in Yemen, he was found to have a heart problem and was advised to undergo heart surgery which was not available in Yemen.

The patient’s parents approached Dr Devananda N S, Head and Consultant – Cardiothoracic Vascular Surgery, Manipal Hospital, Old Airport Road, Bengaluru, for immediate medical support. After a few tests, he was diagnosed with a rare type IV truncus arteriosus disease (congenital heart problem) which was treated immediately by undergoing a full correction surgery on August 25, 2022.

The patient underwent an echocardiogram and cardiac catheterisation at Manipal Hospital to understand the exact health condition. He was diagnosed with a rare congenital heart problem called, type IV truncus arteriosus. In this condition, apart from a large hole in the heart (ventricular septal defect-VSD), the arteries to the lung arise from the aorta after the arch. To complicate the matter, his aorta was coursing to the right instead of the normal left and left lung artery was traveling behind the left lung windpipe instead of coursing in front of it. Generally, other types of truncus arteriosus will become in-operable by this age because of high pressure in the lung circulation causing permanent lung damage. However, this child was still operable. This surgery was executed successfully with the support of the cardiothoracic and vascular surgeons (CTVS) and a multidisciplinary team.

Not just the liver, heart, and kidneys, drinking alcohol can damage your DNA too

"Even when heavy drinkers stopped drinking, their methylation levels did not return to those of non-drinkers, indicating that alcohol-related chemical alterations in the DNA are not reversible," Dr. Bir Sehrawat, HOD and director, department of gastroenterology, Marengo QRG Hospital, Faridabad

Over the years, there has been plenty of research suggesting that drinking alcohol, albeit a little, can help keep your heart in great shape, and that wine may help delay ageing. But experts are now debunking this very finding. According to research by the American Cancer Society, alcohol contributes to more than 75,000 cases of cancer per year and nearly 19,000 cancer deaths. Further, experts suggest that not just the liver, heart, and kidneys, drinking alcohol can also damage the DNA.

Agreed Dr. Bhavana MV, consultant – microbiology, Manipal Hospital, Old Airport Road, Bangalore and said that “there is some evidence that chronic alcoholism can cause some DNA changes and that can contribute to tumour initiation and progression”. “It is known that chronic alcohol consumption is an important risk factor for liver and few of the gastrointestinal cancers,” Dr. Bhavana said.

On the occasion of the Clinical Interventional Radiology Conference (CIRCON) 2023, Dr. Reddi Prasad Yadavali, Chairman, HOD & Consultant – Interventional Radiology, Manipal Hospital Old Airport Road, spoke extensively about different types of IR procedures used to treat both benign disease and cancer with the help of advanced technology. The conference also highlighted the role of IR in patients' pre and post-operative care in treating both early and advanced-stage cancer.

Interventional Radiology (IR) is one of the rapidly growing medical specialties that enables medical professionals to perform pin-hole procedures to diagnose, treat, and cure a range of illnesses using minimally invasive techniques. IR can treat a wide range of conditions such as Uterine fibroids, enlarged prostate, dialysis access, thyroid nodules, hemoptysis (coughing up blood), varicose veins in the legs, liver and kidney cancers, pelvic congestion syndrome, etc. Although IR was first developed in the 1960s, it has taken some time to evolve and get recognition as a super-specialty around the world.

Interventional Radiologists at Manipal Hospitals have been part of many breakthrough procedures to treat cancers, fibroids, dialysis access, arterial diseases, and other many rare conditions. The scope of services of Interventional Radiology includes all organs of the body. The most well-known and largely preferred alternate method used to treat Uterine fibroid is a pin-hole technique called embolisation.

Dr. Reddi Prasad Yadavali, Chairman, HOD & Consultant – Interventional Radiology, Manipal Hospital Old Airport Road, said, “Application of Interventional Radiology is increasing rapidly around the globe. Over the years there has been a steady growth of IR in India. With an increasing number of training programs and official recognition of IR as a super specialty, our country has expanded the practice of Interventional Radiology. Today it has become an integral part of the clinical management of patients with any disease benign or cancer.

Dr. Satyanarayana Mysore, HOD and consultant Pulmonology, Sleep Physician, Manipal Hospital, said, "Manipal Hospitals is awaiting the nasal vaccine which will be administered as a booster dose. The vaccines are yet to be delivered. The demand for booster doses was non-existent a month ago, but with the situation in China, the demand is slowly going up".