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PROTECTIVE FACE MASK IN THE COVID-19 ERA.

Its day 11, third month of the lock down, 6 Am, my usual day for work. I am considered essential, so its business as usual with much enthusiasm for me and some of my mates, except for those few in dentistry.

I am literally in a matatu enjoying the solemn, quiet, chilly misty drive to work, a whole two-seater seat for skinny me! Of course, this was not accidental! GoK has made sure that safety in public transport during this pandemic be a priority, http://www.xinhuanet.com/english/2020-04/06/c_138949862.htm, many thanks to W.H.O global campaigns across the globe on the needful and benefits of sanitizing with alcohol-based hand sanitizers, proper use of face mask and keeping a social but a “friendly” distance.

This was the first pandemic where I had a chance to participate professionally to offer my little expertise in the disease control and management of any possible outcomes. The use of protective facemasks was the only sure way that we’re going to triumph this virus, CORONAVIRUS! Or, ‘CoVid-Virus’ as my 5-year-old angel calls it. She’s probably right, with the much information she could gather in this span.

In Nairobi city, I saw the price of facemask and its demand conversely rise to several folds than expected. Everyone values life, this statement depends on the amount of dollar one spends a day, as one may see it from a different perspective. They, masks, came in rousing designs branded with favourite portraits of nature, celebrities and even country flags (symbolizing patriotism and solidarity). For the political class, BBI inscriptions did not miss! Some customized for the youth and young adults, had favourite money heist- https://www.imdb.com/title/tt6468322/ – cast on them!  All these, to motivate us to put them on appropriately, as recommended by the ministry of health.

Based on the scientific evidence published in major medical journals on the safety of the appropriate use of facemask in the prevention of respiratory infections with specific interest to those due to pathogenic nature, I chose adhering to the guidelines to the later. Even when I am going out for an afternoon walk along the riverbank of The Nairobi River in my in the hood in Kiambu County. I saw a huge problem in the larger population that is cognizant of the catastrophe the globe faces today, but choose to live lackadaisically. They have been living normally, the way our health CS has been quoted on the media, as if everything is perfectly well! Consequently, the results have overwhelmingly expected with a rocketing number of new cases of infections and deaths as observed in Italy. In Kenya today we are 3,215! https://www.worldometers.info/coronavirus/country/kenya/ Majority of the cases in Kenya are from Nairobi and Mombasa counties. Cities are centers of excellence in a particular country. In Kenya, Residents of Nairobi and Mombasa have highest literacy levels but incapable of sane reasoning! Citizens have to policed to wear masks! ‘Sell me one mask I don’t want to be arrested.’ A Nairobi resident at a pharmacy in Hurlingham. It is no wonder our numbers are rising sharply and steadily! These acts have turned our quarantine facilities into a 14-21day cell. Indeed ignorance is no defence!

Fellow practitioners, some of them, unfortunately, fail us in this war by not following the guidelines they encourage the public to adhere. It is my prayer that we all practice what we preach and endeavour to learn. Its only after learning that we shall live to learn even more.

I have made it a personal choice to practice the ritual not as show off but,

  • In respect and in solidarity with my frontline colleagues who depend on PPE for their safety and that of their families.
  • When I am out and about, in my small village I consider myself as an agent of change and as a role model of good behaviour to my angel.
  • Lastly, like those who have come before my time, I believe in the precautionary principle when it comes to this strange and frightening virus.

IMMUNOTHERAPY AND CANCER VACCINE.

Among the many researched current cancer treatment options, IMMUNOTHERAPY and CANCER VACCINES tops the list. One in the field of medical sciences my be deemed as an old-fashioned practitioner if s/he doesn’t know what immunotherapy is all about. Such fellows may not exist in Kenya with the availability of worldwide web – WWW- we’re all on the grid of information.

IMMUNOTHERAPY

So, what is immunotherapy?

Immunotherapy, also called biologic therapy, According to the American Society of Clinical Oncology, ASCO, it is described as a type of cancer treatment that boosts the body’s natural defences to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function.

The science of immunology has been in existence from as early as 5th century BC. Today many amazing applications have saved the world from extinction through human and animal health science. Names like Robert

Koch, Louis Pasteur (Father of Immunology) cannot leave our heads. Edward Jenner eradicated smallpox through the development of vaccines in 1976. Today the world is safer an indication that VACCINES WORK!

Types of immunotherapy.

There are several types of immunotherapy, including:

  • Monoclonal antibodies and tumour-agnostic therapies
  • Non-specific immunotherapies
  • Oncolytic virus therapy
  • T-cell therapy
  • Cancer vaccines

How does immunotherapy work?

  • Stopping or slowing the growth of cancer cells
  • Stopping cancer from spreading to other parts of the body.
  • Helping the immune system work better at destroying cancer cells.

One form of immunotherapy is called an immune checkpoint inhibitor. It takes the brakes off immune cells, unlocking their ability to detect altered proteins on cancer cells in order to attack and kill these cells. These drugs include programmed death (PD-1)-inhibitors and PD-L1-inhibitors (such as pembrolizumab, atezolizumab, nivolumab), and cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors (ipilimumab).

Side effects of immunotherapy.

All drugs have side effects, including the immunotherapy drugs discussed here. Understanding the information below can help if you or a loved one does experience side effects.

These side effects are common but may not occur in all people or with all types of immunotherapies.

  • Feeling tired (fatigue)
  • Diarrhoea.
  • Fever.
  • Shortness of breath.
  • Rash and/or blisters, covering less than 10% of the body.
  • Nausea.
  • Vomiting.
  • Itching.

How are the side effects of immunotherapy managed?

Severe side effects are controlled by stopping the immunotherapy and starting corticosteroids (such as prednisone), which are tapered slowly over a period of weeks. If you’ve had immunotherapy at any time in the past,

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report any new symptom to your treating oncologist before self-medicating with drugs purchased over the counter. For example, if you have diarrhoea, taking loperamide (Imodium) may arrest the symptom. But it won’t address the root cause, which is inflammation of the large intestine. Uncontrolled inflammation of the intestine may lead to rupture of the intestinal wall, which can be life-threatening. Similarly, if you have a cough, consuming cough suppressants (caution for products containing codeine needs monitoring I pediatric use if it is a must,) allows lung inflammation to continue and become potentially life-threatening. Medical advice is sought to better manage the symptoms.

 Antibiotics and immunotherapy.                                                             

As we begin to understand the immune system better, an important nugget of emerging information is that antibiotics may reduce the ability of immunotherapy to kill cancer by killing harmless bacteria that live in the gut. People taking immune checkpoint inhibitors who receive antibiotics are less likely to benefit from immunotherapy than those who do not. Hence, it appears important to avoid unnecessary antibiotics for minor infections, which may be prescribed for patients visiting the ER for fever, cough, or other symptoms suggestive of infections. Check with your cancer team about this.

Challenges and future trends.

  • Unpredictable efficacy.
  • Drug resistance.
  • Cost of immunotherapy drugs re high.
  • Tumour heterogenicity impedes efficacy.
  • Need for more predictive biomarkers.

During recent decades, our understanding of cancer immunology has advanced dramatically. Many obstacles still impede the success of cancer immunotherapies in a wider variety of malignancies and patients. However, the rapid progress that has led to the present era of cancer immunotherapy is expected to continue vastly. Current obstacles will likely be surmounted through the implementation of available and potential solutions, including the development of more targeted cancer immunotherapies; personalized treatment with cancer immunotherapy drug combinations; cancer immunoprevention strategies; and additional important innovations.

Success of immunotherapy.

Although immunoprevention for viral-induced cancers has been successful in the setting of hepatitis B and human papillomavirus vaccination, notably, primary prevention of non-viral-induced cancers is in its conception.

CANCER VACCINES.

 A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.

cancer vaccine is a product used to help the body fight disease. A vaccine exposes the immune system to an antigen. This triggers the immune system to recognize and destroy that antigen or related materials. There are two (2) types of cancer vaccines.

  1. Prevention vaccines.

The administration of preventive vaccines at pre-malignant stages of the disease holds promise, as they function before tumour-associated immune suppression is established. Accordingly, immunological and clinical studies are yielding impressive results.

Certain human cancers, notably prostate adenocarcinoma and cervical cancer, can currently be detected at very early stages of carcinogenesis. Earlier detection of these cancers, combined with existing vaccines directed against them, will soon make them targets for therapeutic vaccination in the preventive setting

This ability to detect cancer in the pre-malignant setting and being able to immunize patients at the very earliest stages of carcinogenesis, when they have fully competent immune systems, has the potential to cause a fundamental change in how therapeutic cancer vaccines are tested and used clinically.

2. Therapeutic vaccines.

Therapeutic cancer vaccines have been extensively tested in patients with advanced cancer but have had little clinical success, which has been attributed to the immunosuppressive tumour microenvironment.

Limitations of vaccines in cancer.

  • Autoimmunity seems to be a major setback in this treatment option.
  • The stage of cancer at which the vaccine is administered also matters a lot. At end-stage very less may be expected as the prognosis is poor.
  • Underlying diseases like immunosuppressed syndromes my hinder expected outcomes of vaccines
  • Prior treatments may also have an effect on vaccinations if immunity was compromised example chemotherapy.

Do vaccines work?

This question has brought a lot of controversies both in the political, medical-science and religious arena.

A story is told of Mithridates VI. He was paranoid about being poisoned and so he would take a little portion of poison throughout his life to develop immunity against It. When he was finally captured by the Romans, he attempted suicide by ingesting poison so that he could die but he could not, he was immune. SIMPLE.  He was captured, of course alive.

You have your answer.

The government of Kenya supports this ideology, there’s a division of vaccines and immunizations, DVI, in the ministry of health with vision of increasing access and reducing morbidity of vaccine preventable deaths. Today in Kenya all new-born to the age of 5yrs get

immunized free of charge as a government initiative to promote immunization.

So, get out there and vaccinate your daughter against human papilloma virus, HPV, don’t let her become vulnerable, for facts will remain facts even if they’re ignored.

Anti-vaccine crusaders alive today should be thankful for those shots they got; they’d otherwise all be dead. EVIDENCE THAT VACCINES WORK!

References.

www.reseachgate.com

cancer.net.org

onclive.com

practiceupdate.com

National Cancer Institute

cdc.org

clinical care options http://www.nhs.uk/news/2009/09September/Pages/Cervical-cancer vaccine-QA.aspx

Cryotherapy. The wonder of oncology.

Cryotherapy is a treatment that uses extreme cold to destroy cancer cells. Cryotherapy can be used to treat a number of different types of cancer and precancerous conditions.

Cryotherapy and cancer.

Cryotherapy uses extreme cold to destroy cancer cells locally. It’s also called cryosurgery or cryoablation. During cryotherapy treatment the doctor freezes the cancer cells to kill them. It doesn’t treat any cancer cells in other parts of the body. After the treatment the body’s immune system gets rid of the dead tissue over a few weeks.

Why you might have this treatment for prostate cancer.

For men with localized advanced prostate cancer this is the best option. Cryotherapy is an effective treatment and minimally invasive with low surgical risk, low morbidity with good results in the long term follow up in terms of survival, biochemical recurrence, cancer-specific survival and overall survival. It is valid technique for organ confined tumors and preferably in low- and intermediate risk groups. Its safe alternative for patients with high surgical risk or contraindication for radiotherapy with low rate of complications it can be repeated in case of biochemical relapse after histological confirmation of local recurrence.

The low rate of complications with the exception of erectile dysfunction, is good basis for the future for the election of cryosurgery s the techniques of choice for the development of prostatic focal therapy. In fact, although on n experimental basis, it is considered in clinical guidelines.

But information about the long-term outlook to find out if it is as good as other treatments at stopping the cancer coming back is still ongoing. Some cancers need to be frozen and thawed a number of times. Depending on the treatment area, it can take from a few minutes to a couple of hours. To help the doctor position the cryoprobe you may have either an ultrasound scan or CT scan. The position of the cancer in the body affects how the doctor puts the cryoprobe into the area. You may have cryotherapy through the skin (percutaneously) or cryotherapy through a scope. You might also have cryotherapy as part of a clinical trial and this may benefit patients with socio-economic strain.

Cryotherapy for changes on the cervix.

To treat precancerous changes on the cervix the doctor or nurse specialist puts a speculum into the vagina so they can see the cervix. They put special instruments called cryo-probes into the vagina so that they firmly cover the abnormal areas of cervical tissue.

The liquid nitrogen in the cryoprobes then freezes the cells. This process might be repeated a couple of times. The treatment usually takes less than half an hour.

You might have period pain during and for a short time afterwards. And you may have some light vaginal bleeding which can last for up to 4 weeks. 

Cryotherapy for skin cancer.

Your doctor sprays liquid nitrogen on to the area of cancer. Or they put it directly on to the area with a cotton swab. The liquid freezes the area. After treatment the liquid nitrogen dissolves and the area thaws.

A scab forms in the area. Over the next month or so the scab falls off along with any dead cancer cells.

Side effects include:

  • pain
  • swelling and redness
  • blistering
  • infection, although this is uncommon

Rare and longer-term side effects might include scarring, numbness in the area and changes in skin colour, it may become either lighter or darker.

Having cryotherapy for cancer inside the body.

For cancers inside the body, a small probe is inserted next to or inside the tumor. This probe is called a cryoprobe. The cryoprobe is attached to a supply of liquid nitrogen controlled by the doctor. Your doctor or specialist nurse will talk to you beforehand about how you will have treatment and exactly what is involved.

There is a HOPE that there is LIGHT despite all of the darkness.

Cryotherapy. The wonder of oncology.

Cryotherapy is a treatment that uses extreme cold to destroy cancer cells. It can be used to treat a number of different types of cancer and precancerous conditions.

Cryotherapy and cancer.

Cryotherapy uses extreme cold to destroy cancer cells locally. It’s also called cryosurgery or cryoablation. During cryotherapy treatment the doctor freezes the cancer cells to kill them. It doesn’t treat any cancer cells in other parts of the body. After the treatment the body’s immune system gets rid of the dead tissue over a few weeks.

Why you might have this treatment for prostate cancer.

For men with localized advanced prostate cancer this is the best option. Cryotherapy is an effective treatment and minimally invasive with low surgical risk, low morbidity with good results in the long term follow up in terms of survival, biochemical recurrence, cancer-specific survival and overall survival. It is valid technique for organ confined tumors and preferably in low- and intermediate risk groups. Its safe alternative for patients with high surgical risk or contraindication for radiotherapy with low rate of complications it can be repeated in case of biochemical relapse after histological confirmation of local recurrence.

The low rate of complications with the exception of erectile dysfunction, is good basis for the future for the election of cryosurgery s the techniques of choice for the development of prostatic focal therapy. In fact, although on n experimental basis, it is considered in clinical guidelines.

But information about the long-term outlook to find out if it is as good as other treatments at stopping the cancer coming back is still ongoing. Some cancers need to be frozen and thawed a number of times. Depending on the treatment area, it can take from a few minutes to a couple of hours. To help the doctor position the cryoprobe you may have either an ultrasound scan or CT scan. The position of the cancer in the body affects how the doctor puts the cryoprobe into the area. You may have cryotherapy through the skin (percutaneously) or cryotherapy through a scope. You might also have cryotherapy as part of a clinical trial and this may benefit patients with socio-economic strain.

Cryotherapy for changes on the cervix.

To treat precancerous changes on the cervix the doctor or nurse specialist puts a speculum into the vagina so they can see the cervix. They put special instruments called cryo-probes into the vagina so that they firmly cover the abnormal areas of cervical tissue.

The liquid nitrogen in the cryoprobes then freezes the cells. This process might be repeated a couple of times. The treatment usually takes less than half an hour.

You might have period pain during and for a short time afterwards. And you may have some light vaginal bleeding which can last for up to 4 weeks. 

Cryotherapy for skin cancer.

Your doctor sprays liquid nitrogen on to the area of cancer. Or they put it directly on to the area with a cotton swab. The liquid freezes the area. After treatment the liquid nitrogen dissolves and the area thaws.

A scab forms in the area. Over the next month or so the scab falls off along with any dead cancer cells.

Side effects include:

  • pain
  • swelling and redness
  • blistering
  • infection, although this is uncommon

Rare and longer-term side effects might include scarring, numbness in the area and changes in skin colour, it may become either lighter or darker.

Having cryotherapy for cancer inside the body.

For cancers inside the body, a small probe is inserted next to or inside the tumor. This probe is called a cryoprobe. The cryoprobe is attached to a supply of liquid nitrogen controlled by the doctor. Your doctor or specialist nurse will talk to you beforehand about how you will have treatment and exactly what is involved.

There is a renewed HOPE , that there is light despite all of the darkness.

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