Health Wikipedia

Very often, women in Bangladesh present to a doctor’s room when their diseases have already progressed to a grave condition and need aggressive treatment. Sometimes, physicians have very little to do with a woman when she comes at the end stage of a fatal disease like cancer. With simple and inexpensive screening tests, women can prevent a range of deadly diseases like cancer, glaucoma, complications of diabetes etc. and help remain heal and hearty.

1. Breast cancer
Diagnosis in the early stages is crucial for breast cancer like other cancers. Mammograms are used as an ideal screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge. A woman should have a mammogram done within 40s. Onwards, they should get an annual screening for early detection, experts recommended. Any discomfort or pain in the breast should be investigated throughly and must not be neglected. Any unusual discharge should be checked out right away. Sometimes doctors recommend ultrasonography and low-dose x-ray can also detect disease at early stage and used as screening tools.

2. Cervical cancer
Cervical cancer is top ranked killer cancer in Bangladesh. It occurs in the cervix, a part of the uterus that extends into the vaginal cavity. Routine screening can find it early, when it is highly curable. It can also find abnormal precancerous cells on the surface of the cervix so they can be removed before they turn into cancer. Doctors recommend VIA (Visual Inspection of Cervix using Acetic Acid) which is given free of cost in the government settings and Pap test to screen for cancer of the cervix. The screening test should start as early as women enter in reproductive age. For better protection FDA approved vaccine cervical cancer vaccine is available in our country; it confers immunity against HPV virus that causes cancer.

3. Osteoporosis and fractured bones
Osteoporosis is a condition in which bones become weak and fragile. It is caused by bone loss, which accelerates in women after menopause. A test called Dual Energy X-ray Absorptiometry (DXA) can measure bone mineral density and detect osteoporosis before fractures occur. It can also help predict the risk of future bone fractures. Bone density testing is recommended for all women 65 years of age and older. It is also recommended for middle-aged women younger than 65 who have risk factors for osteoporosis.

4. Cholesterol levels
A high level of LDL cholesterol (bad cholesterol) is a major factor that increases the risk of developing heart diseases. Doctors screen for problems with cholesterol by using a fasting blood lipid profile. Management decisions are based on the results.

5. Type 2 Diabetes
Measuring the fasting blood glucose and two hours after breakfast are used to screen for diabetes. Experts also recommend another tests called HbA1C. If a woman is healthy and have a normal risk of diabetes, she should have the test done every two years starting at age 45; with higher risk, one should start testing earlier and more frequently.

6. Colorectal cancer
The majority of colon cancers develop from colon polyps that are growths on the inner surface of the colon. A colonoscopy is a common screening test for colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. If a woman is at average risk, screening usually starts at age 50.

7. Glaucoma
Glaucoma is a condition that can result in blindness due to damage to the optic nerve. People older than age 50, family history of glaucoma, personal history of eye injury and steroid use are risk factors for glaucoma. For healthy individuals without increased risk, routine screening every two years is recommended for people under age 40. For those between 40 to 54 years, testing should be done every one to three years. From age 55 to 64, testing should be done every one year, and for those over 65, every six to 12 months.

Despite significant improvement in medical science in recent decades, mothers and their babies in the third world countries like Bangladesh are still at risk during the perinatal period, which covers pregnancy, delivery and the postpartum.

Babies born too early are more likely to die than that of born at term. They are also more likely to have neurological and developmental disorders that carry long-term consequences for their quality of life, their families and for health and social services.

Perinatal health includes care for both mother and their new born babies. But we often forget about the care of the mothers during and after delivery. However, maternal deaths are less than babies. This is a tragic event as a significant proportion of these deaths are associated with substandard care.

When we talk about paediatrics (child care), it only deals with children. And the obstetricians deal with mothers only. But we need to set up a sturdy bridge in between these two separate entities. It is impossible to think about healthy child without healthy mother. In fact, perinatal science deals with a unique two in one health delivery system.

Bangladesh has made a significant progress in reducing maternal and infant death in recent years. This has been possible because of strong leadership of the Ministry of Health and Family Welfare (MOHFW) in creating a supportive policy environment, technical and financial commitment of donors and UN agencies, active engagement of professional bodies and academic institutions. National Neonatal Health Strategy has already been prepared by the MOHFW. Now we need to operationalise the recommendations outlined in the strategy and begin to roll out the crucial interventions needed to prevent unnecessary deaths.

Immediate and early postnatal care for mothers and newborns is one such crucial intervention. Most of maternal and newborn deaths occur within the first three days of childbirth. Therefore we need to deliver the services to them in those crucial days.

Neonatal sepsis (infection of the newborn) is the single largest contributor to neonatal mortality. We need to ensure that the health service providers at community level can prevent, detect and manage sepsis when it occurs. Now operation research is underway to see the feasibility of different approaches in order to determine the best way to deliver this service to the majority of the newborns who are born at home.

We need to strengthen the policies, guidelines and service providers’ capacity to ensure that the neonates and the mothers are not left without care. Unless we can scale up these services to reach the primary level of health system, we will not be able to attain the Millennium Development Goals by 2015. We need to create additional posts of neonatologists and obstetricians at the district hospital level as a starting point.

Prof M Shahidullah.

Cervical cancer is cancer of the cervix — the lower part of the uterus, which opens into the vagina. Cervical cancer is the second-most-common type of cancer that strikes women worldwide after breast cancer.

It is estimated that nearly 250,000 deaths are associated with cervical cancer globally every year. According to the World Health Organisation, there were 500,000 new cases of cervical cancer in 2005.

The tragedy of cervical cancer is that it often strikes when a woman is still young. It tends to happen in women between the age of 35 and 55 years. She may be trying to raise her family or may be she has not had children yet.

A population-based survey reported that the coverage of cervical cancer screening in Bangladesh is less than 1%. Older and poor women are at the highest risk of developing cervical cancer in Bangladesh.

Cause of cervical cancer
99% of cervical cancers are caused by Human Papillomavirus (HPV), which spreads through sexual contact. There are over 100 different types of HPV. The majorities of viruses are considered Low Risk and do not cause cervical cancer. However, HPV-16 and HPV-18 often referred to as High Risk HPV types are associated with more than 70% of cervical cancer cases.

The body’s immune system usually fights off the infection as a result most women never suffer from HPV infection. However, in some women the infection does not go away. When the virus remains active in the body for a long period of time, cervical cells begin to change and the risk of cervical cancer increases.

There are other factors can increase the risk that an HPV infection develops into cervical cancer:

* Sexual intercourse at an early age

* Multiple sexual partners

* Multiple full-term pregnancies

* Chlamydia, gonorrhoea, syphilis, or herpes simplex virus type 2 infection

* Cigarette smoking

* Use of oral contraceptives for a long period of time

* Weakened immune system or HIV infection • Mother or sister with a history of cervical cancer

* Low levels of folic acid (a type of Vitamin B)

Symptoms
Cervical cancer is usually a slow-growing cancer, typically takes 10-15 years before invasive cancer develops. Once cervical cells begin to change, it first becomes “pre-cancerous” a condition also known as “dysplasia” or Cervical Intraepithelial Neoplasia (CIN).

In the early stages cervical cancer often causes no symptoms. However, when symptoms do occur, they may include:

* Bleeding between regular menstrual periods

* Bleeding after sexual intercourse

* Bleeding after douching

* Bleeding after a pelvic exam

* Pelvic pain not related to your menstrual cycle

* Heavy or unusual discharge that may be watery, thick, and possibly have a foul odor

* Increased urinary frequency

* Pain during urination

These symptoms can be caused by cervical cancer, or by a number of serious conditions, and should be evaluated promptly by a medical professional.

Diagnosis
Cervical cancer is diagnosed through a series of examinations. A Pap test is most commonly used to screen and detect the possibility of a cervical cancer or dysplasia.

An HPV DNA test is used to determine the high-risk strains of HPV infection, which is most likely to lead to cervical cancer. If an abnormality is found during a Pap and HPV DNA tests, a Colposcopy is performed.

Finally, a Cone biopsy is performed by removing a cone-shaped piece of tissue from the cervix for microscopic examination. A pathologist examines the sample for confirmation of precancer or cancer cells.

Treatment
Options for treating cervical cancer depend predominantly on the stage of disease — the size of the tumor, the depth of invasion, and whether the cancer has spread to other parts of the body.

Other factors that are considered are the patient’s age and if she wishes to have children. The primary forms of treatment are surgery or combined radiation therapy and chemotherapy.

* Surgery to remove the uterus

* Radiation therapy to kill the cancer cells

* Chemotherapy to stop the growth of cancer cells

Vaccine
The vaccine is now available for prevention of HPV infection. Studies show that women who receive cervical cancer vaccine between the ages of 15 and 25 have 100% protection against the HPV-16 and HPV-18.

The vaccine is given in three shots over six-months. Centers for Disease Control and Prevention (CDC) recommended this vaccine for girl’s ages 11 to 12, although it may be used in girls as young as age 9.

Ideally, females should get the vaccine before they are sexually active. The vaccine is also recommended for 13-26 year-old girls who have not yet received or completed the vaccine series. This allows a girls immune system to be activated before she encounters HPV. Vaccinating at this age also allows developing the highest antibody levels. The higher the antibody levels the greater the protection.

Abu Siddiqui…

Many women may not be fully aware of the potential consequences of waiting until later in life to have a baby, a UK study suggests.

The study, of 724 women who were either pregnant or having trouble getting pregnant, found that nearly all were aware that age affects the chances of conceiving. However, they often did not know that older age increases the risk of certain pregnancy complications, and many had too much faith in the success of in-vitro fertilisation (IVF).

The decision to delay childbirth is a complex and personal one, the researchers note in a report in the journal Fertility & Sterility.

The point, they say, is that women should be fully aware of all the possible benefits and risks of their decision.

“The results of this and other studies suggest that women should be provided with the appropriate information on the possible outcomes of a decision to delay motherhood,” write Dr. Abha Maheshwari and colleagues at the University of Aberdeen in England.

When it came to IVF, Maheshwari’s team found that women tended to be overly optimistic about its success rates.

Only 53 percent of women with fertility problems knew that the chances of conceiving via IVF decline between the ages of 30 and 40. What’s more, 85 percent of them thought that fertility treatment can “overcome the effect of age.”

In reality, the researchers note, only 25 percent to 30 percent of women in their 20s and 30s give birth after IVF treatment. Among women older than 40, the success rate is closer to 10 percent.

Yet many people may not realise that IVF frequently fails, Maheshwari’s team writes — possibly because much of what they hear about IVF comes in the form of media stories on older women who have successfully conceived through fertility treatment.

“Many women are currently choosing to delay motherhood in the interests of personal and professional development,” the researchers write. “Although starting a family is a personal preference, free choices cannot be made without full knowledge of their consequences.”

Researchers who tracked breast cancer rates in Norwegian women proposed the controversial notion on Monday that some tumors found with mammograms might otherwise naturally disappear on their own if left undetected.

But leading cancer experts expressed doubt about the findings and urged women to continue to get regular mammograms, saying this screening technique unquestionably saves lives by finding breast cancer early on when it is most treatable.

Dr. Per-Henrik Zahl of the Norwegian Institute of Public Health in Oslo and Norwegian and U.S. colleagues examined invasive breast cancer rates among nearly 120,000 women age 50 to 64 who had a mammogram — an X-ray of the breast used to find evidence of cancer — every two years over a six-year period.

They compared the number of breast cancers detected with another group of about 110,000 Norwegian women of the same age and similar backgrounds who were screened just once at the end of the six-year period.

The researchers said they expected to find no differences in breast cancer rates but instead found 22 percent more invasive breast tumors in the group who had mammograms every two years.

Mammography and breast self-examination for tumors are standard methods used for early detection of breast cancer, the leading cause of cancer deaths among women worldwide.

The American Cancer Society estimated that about 465,000 women die of breast cancer globally each year, and 1.3 million new cases are diagnosed.

The researchers acknowledged many doctors might be skeptical of the idea but they cited 32 reported cases of a breast cancer regressing, a small number for such a common disease.

Any antibiotic, chemical or drug based substance consumed during pregnancy may reach the fetus (the baby inside the uterus) through maternal circulation. Antibiotics that are able to cross the placenta are potentially harmful and cause adverse fetal effects during pregnancy. The effects depend highly on the type and dose of antibiotic. Not only in pregnancy but certain antibiotics are able to pass from mother to her baby through breast milk.

The Food and Drug Administration (FDA) established five pregnancy categories to indicate the risk level of drugs to the fetus. The categories are A-B-C-D and X. The category A being the least dangerous during pregnancy and category X to be completely avoided

Category X: Highly dangerous
Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities or risks.

Quinolones: Sparfloxacin (1st trimester)

Category D
Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.

Tetracycline: Tetracycline, Doxycycline, Oxytetracycline

Others: Naproxen (3rd trimester)

Category C
Animal studies have shown an adverse effect but there are no adequate and well-controlled studies in pregnant women.

Quinolones: Cipro-floxacin, Levofloxacin, Moxifloxacin, Gatifloxacin, Ofloxacin, Sparfloxacin (2nd and 3rd trimester)

Macrolides: Clarithromycin

Aminoglycosides: Gentamicin

Others: Chloramphenicol

Category B
Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Penicillin: Amoxicillin, Ampicillin, Cloxacillin, Flucloxacillin

Cephalosporins: Cephalexin, Cefradine ( First generation); Cefuroxime ( Second Generation); Cefixime, Cefpodoxime, Cefotaxime, Ceftriaxone ( Third Generation)

Macrolides: Azithromycin, Erythromycin

Sulphonamides: Clotrimazole

Others: Metronidazoles, Naproxen (1st and 2nd trimester)

Category A: Least dangerous
Theoretically there are no antibiotics in this class for pregnancy.

Md Sojib Khan……