“We are sorry to inform you that your submission is rejected”- This is something you never want to hear or read but this is most often experienced. These words are disheartening. When we start research, it becomes a dream to see that work turning into pages of a journal. But after so much hard work and research what is something that we lack? This blog will unlock your mysteries and let you know the reasons behind that NO, that rejection. Let’s find out what goes wrong and what one should do.
Technical Screening turning into a failure
The first problem can be in your basic check. From plagiarism to figures, something has gone wrong. In technical Screening, manuscript is rejected if: –
There is some issue with language
Imprecise hypothesis
Main titles, references, list of authors etc. crucial elements are missing
There is no proper conclusion
Flaws in study design
2. Deviation from aim and outlook of journal
The biggest and smallest mistake we can do is not finding the perfect journal. Before sending your submission, one must know what the aim and scope of the journal is. If your manuscript is not adding any value to the journal, they will reject it. To learn how to find where to publish and how to find that right key visit https://lnkd.in/drKKnPHe
3. Do not Put your feet in two boats
Journals usually mention that if your work is under review at some other place then they will not consider it. So, do not submit your work at two journals, you might sink. Find the journal interested in your research and focus in one direction.
4. Format it before sending
Journals have their own writing style, their way of transforming the manuscript. It begins from font size, font style and can never end because definitive amount of margin is also essential for a journal. So, it is especially important to meet the standards set by a journal and follow the instructions about guidelines.
5. Finding Originality and Significance
If your submission is extension or another version of some research paper, you have high chances of getting a NO. If the journal does not find any significance in what you are trying to convey then also your submission is rejected.
Take Away Points
For the buds of researching world, it is challenging to get their manuscript accepted. But if you know the secrets and tips to the road, this world is welcoming. The world of publishing and medical writing is a place where you need to know what, why and where. Planning matters here.
To turn the “NO” into “YES”, Turacoz is conducting a webinar on Publishing Planning, and this is your chance to track https://lnkd.in/drKKnPHe
Peer Review is the process of evaluation of manuscripts submitted for scientific publication in journals/books, pre-clinical or clinical study reports, research progress reports etc., by experts or peers with similar competence as manuscript authors. It plays a pivotal role in scholarly publications with objective to ascertain quality, reliability and credibility of the work reported in the manuscripts and reports through qualitative scrutiny. This contributes to the acceptability of scientific work as authentic, rigorous and coherent for the intended purpose. Also, it widens networking opportunities within the scientific fraternity.
Types of Peer Review
Single blind review: This is the traditional and most common type of review in which the reviewer’s name is hidden from the author.
Double-blind review: In this kind of review, there is anonymity of both the author and the reviewer to each other.
Open review: The identity of the author and the reviewer are known to each other and there is more transparent communication during the review process.
Peer-review is a golden practice to improve the quality of publications but comes with its own set of disadvantages and shortcomings. Table 1 details the various featural pros and cons of different types of peer-review.
Table 1 Advantages and Disadvantages of Peer-Reviewing [1]
Ethics of Peer Review
As the reviewing experts are essentially from the same area or field of the study as of the authors of documents under review, some conflict of interests or differences in viewpoints may introduce bias that might come in the way of a fair peer review. For instance, a reviewer may not accept the manuscript/report under review if the author’s hypothesis is different from that of the reviewer. Indeed, many journals take this possibility into account and allow the authors submitting manuscripts to give the name(s) of reviewers to whom the manuscript should not be sent for review in addition to names of reviewers the authors would like to recommend. But then, peer review by reviewers recommended by the authors may also occasionally lead to undeservingly favored evaluation.
To avoid undesirable contentions, it is a prerogative for a peer-reviewer to adhere to ethical guidelines outlined by the Committee of Publication Ethics (COPE), which categorises the ethical responsibility of a peer-review into confidentiality of the data reviewed, objectivity of the review process and diligence towards their competency, following processes, policies and conduct [6].
A few ethical practices that should be incorporated in peer-reviewing are as follows:
Maintaining objectivity and diligence in assessing a document
Avoiding any favoritism or likewise, negative bias
Respecting confidentiality of the manuscript
Avoiding giving any personal or derogatory remarks
Refraining from disrespectful tone of criticism
Maintaining timeliness
Adhering to the rationales, norms, policies and specific scope of the journal
Promptly reporting any unethical duplication or data fabrication/design
Staying discrete from the author during the review process to avoid any unwanted confrontation
Essential Components of Peer-Reviewing
Studies conducted by scientists/experts/professional are rendered into a detailed article or manuscript, a draft of which is then sent to the journal editor. The article is sent by the journal editor to peer reviewers before publication. The reviewers then assess the manuscript and extend their comments focusing on the following aspects:
Adequacy of the background information (literature survey) justifying the necessity and purpose of the study reported
Appropriateness and adequacy of the materials and methods employed to generate the data
Compliance to national and international regulatory requirements [e.g. Good Laboratory/Manufacturing/Clinical Practices (GLP/GMP/GCP), Animal ethics, OECD/ICH/USFDA guidelines etc.]
Analysis of data using appropriate (statistical) methods
Proper interpretation and discussion of the data/results and the conclusions drawn.
Originality of the study
Presentation of the manuscript relying on legible and comprehendible language that is grammatically, technically and scientifically correct
Innovations in Peer Review
Any advancement or innovation in a process primarily requires recognition of the prevalent roadblocks. “Necessity is the mother of invention”, Plato’s misattributed proverb reflects the rationale of some compelling advancements that peer-reviewing attributes to the share of challenges it had faced.” Addressing some fundamental conundrums, there are many driven groups across the scientific fraternity who have offer valuable innovative answers.
Raising the satisfaction quotient of the author-reviewer-editor trilogy by ‘Volunpeers’
Lack of familiarity with the subject matter causes many reviewers to decline from reviewing. To overcome this challenge, the journal of Molecular biology enabled a Reviewer Recognition Platform, that facilitates reviewers, christened as ‘Volunpeers’ (to represent the rationale of this platform), to register for their area of expertise and receive manuscripts for reviewing according to their preference. The outcome of this platform was impressive! It proudly flaunted a high rate of involvement and satisfaction from both the reviewer and the editor and establishes a faith that peer reviewing indeed has not reached an intimidating stagnancy. Figure 1 indicates the promisingly positive impacts of Volunpeer-ing on various critical aspects [2].
Figure 1: Impact of Peer-Reviewing through the Reviewer Recognition Platform ‘Volunpeer’
Expediting the process of review and making it less cumbersome and time‑consuming
The dichotomy of time versus quality lead many to attempt to address long and tiresome process of reviewing. Recently, The Journal of Bone & Joint Surgery (JBJS) has initiated below mentioned tiny steps to upgrade their overall peer-review process [3].
Automated and weekly reminder emails to editors
Weekly reminder emails for editor queue statistics
Monthly emails delineating acceptance rates and transfer rates by editor
Shortened deadlines for peer-reviewing
Addition of manuscript Xtract in Editorial Manager that reduces manual entry for basic data like manuscript title, author-names, abstract and affiliations
Refining the review process by spotting errors and maintaining quality standards of review
The quality of any manuscript proportions directly to the errors established during review and editing process. A keen study conducted on ‘Improving the peer-review process and editorial quality by studying key errors escaping the review and editorial process in top scientific journals [4]. Figure 1 shows the common trend of errors encountered during review.
Figure 1: Proportion and types of errors during review/editing process [4]
The recognition of these error-patterns led to the application of a novel mistake index, independent of the journal’s impact factor. Mistake Index Total (MIT) represented the fraction of corrections published by total number of items published in a year and Mistake Index Paper (MIP) represented the fraction of corrections published by the total number of papers (categorised by articles) published in a year. These were then statistically analysed and applied on scientific journals of diverse disciplines to determine the type, rate of occurrence and severity of errors encountered. It is hence recommended that a detailed guideline based upon MIT and MIP be provided to reviewers, authors and editors, which can help them minimise error redundancy, reduce time-to-correction and reinforce quality of published manuscripts [4].
Ensuring recruitment of competent reviewers and providing visibility, value and appreciation for their efforts by R-index
On a more humane level, getting good reviewers and providing visibility, value and appreciation for their efforts stays a huge contributing factor to optimising the quality and efficiency of peer-review. Lack of recognition of time and valuable expertise of the reviewer often is a big dampener for review quality. A simple yet cutting-edge R-index (Reviewer index), has emerged as an essential metric to quantify and credit a scientist’s contribution as a reviewer, regardless of his/her stage of career. Based on the list of reviewers for any particular journal, number of papers reviewed, total number of words against the journal’s impact factor, and eventually fostered by the editor’s feedback on individual review, a score ranging from 0 to 1 is credited to the reviewers. Widely being accepted and implemented, this index is open doors to a wider academic productivity and increased transparency within the scientific community and works reciprocally towards maintaining and enhancing the quality of reviewing [5].
Conclusion
With a fair share of recognition as well as criticism that it comes with, peer-review is undoubtedly an essential component of the publication world. Although an overall positive impact and effectiveness of peer review mechanism to improve upon quality in biomedical journals has been observed in clinical trial and other comparative study publications, it is still difficult to ascertain its tangible impact, considering the aforesaid challenges [7]. Nevertheless, the brighter side shows that the existing peer-review paradigm is inevitably treading towards innovations; profoundly embedded into the process of scientific progress, its indispensable purpose gives reasons enough to boost its operations and we hope to witness more streamlining, transparency, efficiency, robustness and inventive tableaus in its modus operandi.
Turacoz Healthcare Solutions aims to provide information on the latest trends, updates and advances to help researchers stay abreast of important innovations in peer-review in the field of scientific publications. Turacoz Healthcare provides an end-to-end support for scientific communications, clinical trial documents and disclosures, regulatory documents writing and submissions, and medico-marketing writing along with e-modules & e-books on healthcare and research.
Psoriasis is not all of you, it is just a part of you like everything else
Psoriasis is generally classified based on the severity of the disease from mild to severe with a Psoriasis Area Severity Index (PASI) scale. Based on this severity index treatment is given to the patients.
The score comprises of 3 features of psoriatic plaque:
Redness
Scaling
Thickness, which are assigned a number from 0 (none) to 4 (worst).
The extent of involvement of each region of the body (12 regions) is scored from 0 to 6. The total score is a range of 72. There are many studies that quote the improvement with this index which help to know the drug’s effectiveness. For example, if a patient cleared 75% of his psoriatic lesions then it is described as “PASI 75”. These scores are used by clinicians to follow their patient’s progress.
Psoriasis Management:
Some general recommendations for treatment of psoriasis,
Topical application of corticosteroids in the form of ointments, creams, gels, liquids, sprays etc. Example: Keratolytics and calcipotriene, others include anthralin and tars.
PUVA (psoralen plus ultraviolet A) is also an effective treatment.
Conventional treatment methods:
Usage of methotrexate, which is an effective therapy in the majority of patients but has the potential for hepatotoxicity and is contraindicated in some situations.
CyA (cyclosporine), another immunosuppressive medication, also an effective treatment for psoriatic patients.
Acitretin, a systemic agent which is effective and used for the treatment of psoriasis.
Biological agents are proteins that are extracted from animal tissue or can be produced by recombinant DNA technology that possesses pharmacological activity.
Few biologics that target pathogenic T cells include Alefacet and Efalizumab.
Few other biologics target TNF inhibitors for the treatment of psoriasis include Adalimumab Etanercept, and Infliximab.
Psoriasis can also be managed by education and advocacy. Also should promote awareness and understanding of the disease, ensuring access to treatment and supporting research that can lead to effective management.
Psoriasis Prevention:
Psoriasis is a chronic disorder that requires long-term monitoring for treatment response, adverse events and new comorbidities. Also there is a poor adherence to treatment to obtain good results for patients with psoriasis. Hence, there is no way to completely prevent or avoid the occurrence of psoriasis instead taking some precautionary steps can improvise the symptoms and help reduce number of psoriasis flare-ups. Few preventive measures that a psoriatic patient can do to reduce the flare ups.
Taking care of the skin, scalp, and nails and other areas where psoriasis can spread.
Trying some psoriasis creams or ointments that can keep the body moisturized all the time.
Taking sunbath for some time also helps in reducing the psoriatic skin cells.
Try to avoid few medications which can flare up the disease.
Psoriasis can spread easily in cold, dry climates and it is always better to avoid such environmental conditions.
Quit smoking and reduce alcohol consumption.
Lifestyle interventions where symptoms can get worse with stress and anxiety so need to avoid such situations. To avoid such conditions patients can start their day with yoga, meditation, and other exercises.
Taking a well-balanced diet.
Some health tips to bring symptom relief:
Keep the skin moist all the time by applying moisturizers
Take warm bathes that helps in skin soothing
Expose the body to small doses of ultraviolet light in the sunlight
Do not irritate or scratch the psoriatic skin patches
Limit intake of alcohol and stop smoking
Start the day with stressbusters like yoga or meditation to relieve from tensions and emotions
Consider some dietary changes by reducing the intake of sugars, white flour, gluten, caffeine, oils etc.
Diagnosis of psoriasis is not the end but the journey continues with normal ups and downs as with anyone else. Having a disease is not a battle lost but losing hope is defeat. So keep up hope and there are answers to every problems and let’s keep finding them and spreading them.
Turacoz Healthcare Solutions is a socially responsible medical communication company which delivers high quality medical content related to scientific publication (manuscript, review, poster, abstract, case report), regulatory documents (protocol, CSR, narratives, clinical trial disclosure, web synopsis) and marketing documents (print and digital).
Sarcoma, may be defined as “a malignant tumor of connective or other non-epithelial tissue.” It occurs in the connective tissue of the body including fat, blood vessels, nerves, bones, muscles, deep skin tissues, and the cartilage.
Types of Sarcoma
Liposarcoma
Most common soft tissue sarcoma. Develops in the deep fatty tissue. They are firm, bumpy, and invade the surrounding tissues invasively
Fibrosarcoma
Occur in the arms, legs, or the trunk. Occur around scars, muscles, tissues, tendons, and around the lining of the bone
Dermatofibrosarcoma Protuberans
Develops as tumor outgrowths forming outside the skin and are commonly observed on the back or the abdomen. If untreated, the tumor may break through the skin leaving an open wound
Malignant Fibrous Histiocytoma
Types include storiform pleomorphic, myxoid malignant fibrous histiocytoma, malignant giant cell tumor of soft parts, and inflammatory malignant fibrous histiocytoma. Usually observed in patients above 50 yr of age and occurs more commonly in men than women.
Synovial Cell Sarcoma
Occurs most commonly next to a joint in the arms or legs. This type of sarcoma is very painful and is usually treated with radiation, chemotherapy, or amputation combined with chemotherapy.
Epithelioid Sarcomas
Occurs in hand and foot of younger adults. Appears like small nodules. Difficult to treat with surgical intervention and treated with amputation.
Rhabdomyosarcomas
Accounts for nearly half of sarcomas in children. Types include embryonal, alveolar, botryoid, and pleomorphic rhabdomyosarcoma.
Leiomyosarcoma and Uterine Sarcoma
Occurs in the smooth muscles mainly in the gastrointestinal tract and the uterus. Metastases occurs in half of the patients and is usually treated with total abdominal hysterectomy.
Gastrointestinal Sarcoma
Results in the formation of stroma in the stomach and intestines. Treated with Gleeve (a biological agent that retards the activity of gtenes required for the growth of tumor).
Alveolar Soft-Parts Sarcoma
Very rare type of sarcoma which usually occurs in female adolescents and young adults. Slow growing tumor found in extremities and metastases into the lungs.
Kaposi’s Sarcoma
A condition in which cancerous cells are found underneath the skin or mucous membranes (mouth, nose, or anus). Commonly occurs in older Jewish, Italian, or Mediterranean men, patients receiving organ transplant, and patients with AIDS.
The diagnosis of sarcoma is extremely rare worldwide. Often, patients do not experience any pain or discomfort due to the presence of sarcoma which is the most common reason for its late diagnosis. The diagnosis is confirmed after a series of tests including biopsies, computed topography scan (CT-scan), positron emission tomography scan (PET scan), X-ray, magnetic resonance imaging (MRI), ultrasound, and laparoscopic procedure. In most cases, patients have already gone through immense amount of stress until the diagnosis of sarcoma is confirmed. Developing a thorough treatment plan for sarcoma is only possible with a confirmed diagnosis of the condition. The presently available treatments for soft tissue sarcoma include surgery, radiation therapy, chemotherapy, interventional radiology, and targeted therapy.
The National Cancer Institute recommends different treatment options as per the stage of sarcoma.
Stage I adult soft tissue sarcoma
Surgical removal of the tumor along with radiation therapy either before or after the surgery.
Stage II adult soft tissue sarcoma
Surgery to remove the tumor; radiation therapy before or after the surgery; radiation therapy or chemotherapy before limb sparing surgery; and high dose radiation therapy for tumors that cannot be removed by surgery
Stage III adult soft tissue sarcoma that has spread to the lymph nodes (advanced)
Surgery with lymphadenectomy followed by radiation therapy; a clinical trial of surgery followed by chemotherapy; and a clinical trial of regional hyperthermia therapy
Stage IV adult soft tissue sarcoma
Includes chemotherapy and surgery to remove cancer that has spread to the lungs
The duration and intensity of sarcoma therapy can be astonishing and unsettling for patients and their families, and coping with the adverse effects of treatments can be a major and drastic challenge.
There are many NGOs which aides’ new patients and their loved ones to comprehend a sarcoma diagnosis, look for the best care, manage treatment, adapts well and find support.
Ramadan is a lunar based fasting month for Muslims. Muslims who fast during this time should refrain from eating, drinking, use of oral medications and smoking from predawn to post sunset, with no restrictions on food or fluid intake between sunset and dawn. Muslims with diabetes insist on fasting during the holy month, thus creating challenge for themselves and their health care providers. In this article we enumerated some risk factors associated with diabetic patients and how to manage diabetes in Ramadan, according to the ADA recommendations shared in 2005.
Risk associated with fasting in patients with diabetes.
Hypoglycemia: Reduced food intake is a well-known risk factor for developing hypoglycemia. The effect of fasting during Ramadan on hypoglycemic rates is not well known. But, in a study conducted it was observed that fasting during Ramadan increased the risk of severe hypoglycemia by 4.7 fold in patients with type 1 diabetes and 7.5-fold in patients with type 2 diabetes. In addition, the risk of severe hypoglycemia was more common in patient in whose dosage of oral hypoglycemic agents or insulin was changed as well as those who reported a significant change in their lifestyle.
Hyperglycemia: Glycemic control deteriorated, improved, or showed no change in patients who fasted during Ramadan. A study conducted showed 5 fold increase in the incidence of severe hyperglycemia (required hospitalization) for patients with type 2 diabetes and 3 fold increase in the incidence of severe hyperglycemia with or without ketoacidosis in patients with type 1 diabetes. This can be attributed to excess reduction in medication dose for preventing hypoglycemia. Patients with reported increase in food and/or sugar intake had higher rates of severe hyperglycemia.
Diabetic ketoacidosis: Patients with type 1 diabetes fasting during Ramadan have a greater risk of developing diabetic ketoacidosis, especially if their diabetes is poorly controlled. The risk is increased even further because of excessive reduction of insulin dose as food intake too is relatively reduced during that time.
Dehydration and thrombosis: Fluid intake limitation during the fast if prolonged, leads to dehydration (becomes severe in hot and humid climates and in patients who perform physical labor).
Hyperglycemia causes an osmotic diuresis, adding to the volume and electrolyte depletion. In patients with preexisting autonomic neuropathy orthostatic hypotension may be developed. Syncope, falls, injuries, and bone fractures may occur from hypovolemia and the associated hypotension. Blood viscosity may be increased due to dehydration, which may enhance the risk of thrombosis and stroke.
Managing diabetes in Ramadan
Frequent monitoring of glycaemia: especially important for patients with type 1 & 2 diabetes requiring insulin.
Nutrition: Have a well-balanced diet. Avoid large amount of food rich in carbohydrates and fats at sunset. Foods having complex carbohydrate ((slow digesting foods) should be had as a predawn meal and must be eaten as late as possible before start of daily fast. Fluid intake must be increased during non-fasting hours.
Exercise: Normal physical activity may be maintained. Avoid excessive physical activity, which can lead to higher risk of hypoglycemia, especially during few hours before sunset meal.
Breaking the fast: Fast must be broken if
Feeling hypoglycemic (blood glucose of 60 mg/dl). Blood glucose may drop further if treatment is delayed.
Blood glucose reaches 70 mg/dl in first few hours after start of sunset and especially if insulin, sulfonylurea drugs, or meglitinide are taken at predawn.
Blood glucose exceeds 300 mg/dl.
Avoid fasting on sick days
Pre-Ramadan medical assessment: should be undertaken 1–2 months before Ramadan. During this time, appropriate blood studies need to be done and evaluated. Individualized advice must be provided if there is any potential risk to the patient. In addition, necessary changes in diet or medication regimen should be made.
Ramadan-focused structured diabetes education: Healthcare professionals need to be trained to deliver structured diabetes education during Ramadan, which should include:
Glucose monitoring importance during fasting and nonfasting hours.
When fast should not be done or stopped.
Planning of meal if feeling hypoglycemic and dehydrated during long fasting hours.
Timing and intensity of physical activity during fasting.
Importance of diabetes-related medications and its risk during fasting.
Managing of patients with type 1 diabetes
Close monitoring and frequent insulin adjustments are essential for avoiding hypo- or hyperglycemia in patients with type 1 diabetes.
Continuous subcutaneous insulin infusion (pump) management can also be done, but is substantially expensive.
Managing of patients with type 2 diabetes:
Diet-controlled patients : there is a potential risk for occurrence of postprandial hyperglycemia in type 2 diabetic patients. In such cases:
Spreading calories over 2 to 3 smaller meals during the nonfasting interval may help in preventing excessive postprandial hyperglycemia.
Intensity and timing of physical activity may be modified e.g.,2 h after the sunset meal.
Patients treated with oral agents: choice of oral agents should be individualized.
Patients on metformin : have limited possibility of severe hypoglycemia and may fast safely. However, dose timing should be modified so as to provide 2/3rd total daily dose with the sunset meal and the 1/3rd before the predawn meal.
Use of sulfonylurea’s: is unsuitable for use during Ramadan as it posses inherent risk of hypoglycemia. Use of these drugs should be done with individualized with caution. Chlorpropamide use is contraindicated during Ramadan due to risk of prolonged and unpredictable hypoglycemia.
Short-acting insulin secretagogues: could be taken two times daily before the sunset and predawn meals.
Incretin-based therapy: drugs such as Exenatide in particular, can be given before meals to minimize appetite and promote weight loss. Due to its short half-life of 2 hrs, it’s not associated a substantial effect on fasting glucose.
Patients treated with insulin: To maintain necessary levels of basal insulin and preventing fasting hyperglycemia, use of intermediate- or long acting insulin preparations and short acting insulin need to be given before meals. Also, injecting long-acting or intermediate-acting insulin can give adequate coverage in few patients as long as dosage is appropriately individualized.
Insulin Pumps: Frequent glucose monitoring is needed due to failure of the pump infusion site can result in severe deterioration in control over a few hours. Patients with type 1 diabetes must be fully educated and facile about the use of an insulin pump. Before Ramadan, they should receive adequate training and education with respect to self management and insulin dose adjustment. Also, how to adjust their infusion rates as per results of frequent home blood glucose monitoring must be taught.
Pregnancy and fasting during Ramadan: Women with presentational or gestational diabetes are at increasingly high risk and should be strongly advised not to fast during Ramadan. However, if they insist to fast, then special attention must be given to their care. Pre-Ramadan evaluation of their medical condition should be carried out that includes, preconception care with emphasis on achieving near-normal blood glucose and A1C values, counseling regarding maternal and fetal complications associated with poor glycemic control, self management education skills. These patients should be managed in high-risk clinics having obstetrician, diabelogists, a nutritionist, and diabetes nurse educators. Appropriate diet and intensive insulin therapy should be given to pregnant patients. In addition, frequent monitoring and insulin dose adjustment is necessary.
Management of hypertension and dyslipidemia: Dehydration, volume depletion, and tendency towards hypotension may occur with fasting during Ramadan, especially if fasting is extended for long and is also linked with increased perspiration. Therefore, dose and/or type of anti-hypertensive medications should be adjusted for preventing hypotension. Further, proper counseling need to be given and agents previously given for managing elevated cholesterol and triglycerides should be continued.
Key messages
Fasting by diabetic patients should be done after prolonged discussion with their health care provider so as to discuss the risks involved. Patients, who insist on fasting in Ramadan, must undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. Newer pharmacological agents have lesser hypoglycemic potential and can be specifically useful during Ramadan. Similarly, insulin pump therapy can give greater safety in Ramadan setting.
Read more at
Al-Arouj M,Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et.al, Recommendations for Management of Diabetes During Ramadan. Diabetes Care; 2010.33 (8), 1895-1902.
Sarcomas are the tumors originating from mesenchyme and contribute to about 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers. Sarcoma develops in connective tissue-cells that connect or support other types of tissue in the body. These forms of tumor are most common in normal connective tissues of bones, muscles, tendons, cartilage, nerves, fat, blood vessels of arms and legs, but they can occur anywhere.
What is Sarcoma awareness month?
The majority of patients present in advanced stage of diseases mainly due to ignorance of disease as well as apprehension and fear of surgery. The economic constraints also delay the detection and management. The awareness for the disease is far less and hence the importance of July as the ‘Sarcoma awareness month’, giving a right opportunity to learn more about the disease, spreading awareness to everyone and making difference in lives of patients fighting sarcoma.
Types of Sarcomas
Though sarcomas are more than 50 types, they can be classified into two main kinds: soft tissue sarcoma and bone sarcoma or osteosarcoma. The sarcomas are further sub-classified into based on type of presumed cell of origin found in the tumor. All of these types have certain microscopic characteristics and similar symptoms.
Who is affected?
Sarcomas develop in both children and adults. In children of less than 20 years of age, 15% (approximately) of diagnosed cancer are sarcomas. In adults, about 1 out of 100 adult cancer cases are soft tissue sarcomas. Osteosarcomas are still rare. Treatment of sarcomas is by surgery for tumor removal.
Risk factors
Most sarcomas have no known cause. Following factors can contribute to risk factors for developing sarcomas:
Previous radiation therapy for cancer.
Genetic disorder such as neurofibromatosis type I, Gardner syndrome, Werner syndrome, nevoid basal cell carcinoma syndrome, tuberous sclerosis, Li-Fraumeni syndrome or retinoblastoma.
Exposure to chemicals such as vinyl chloride monomer used for making plastics.
Symptoms
There may be no signs and symptoms initially or these symptoms may be caused by medical condition, which is not cancer. Soft tissue sarcomas are usually hard to be spot as they grow anywhere in the body.
First signs of sarcoma in an arm, leg, or torso could be painless lump or swelling. These lumps may get bigger as time progresses and might press against nerve or muscles making one uncomfortable or give breathing trouble or both. Unfortunately, there are no tests that can detect these tumors before symptoms occur.
Most often lumps may not be sarcomas and soft-tissue lumps are lipomas, which are made of fat cells and not cancerous. Sarcomas in abdomen may not have any symptoms, or may cause pain or give sense of fullness.
Symptoms or osteosarcoma are more evident, including:
On and off pain in the affected bone, that may be worse at night.
Swelling that often starts weeks after the pain.
Limp, if sarcoma is present in the leg.
Diagnosis
Biopsy: is the only way to find for certain if tumor is a sarcoma.
If biopsy is not possible, other tests may be suggested that can be useful for diagnosis. Imaging tests can be used to find out if cancer has metastasized.
Before choosing diagnostic test following factors may be considered:
Age and medical condition
Type of cancer suspected
Severity of symptoms
Earlier test results
Imaging tests used before or after biopsy for determining location and extent of tumor includes:
Ultrasound
Chest X-ray
CT or CAT (computed axial tomography)
MRI (magnetic resonance imaging) scans
PET (positron emission tomography) scans
Bone scan – for osteosarcoma
Treatments
If sarcoma is diagnosed, treatment may depend of several factors that include:
Location and type of sarcoma.
Spread of cancer.
Impact on body.
Health in general.
Depending on above parameters, treatment for sarcoma is customized as per the needs and may include one or more of the following:
Surgery: is done to remove tumor out of the body. In osteosarcoma, only cancer cells can be removed and arm or leg won’t be amputed.
Chemotherapy: may be used as main treatment of sarcoma or with surgery or radiation. Combination of two or more chemotherapy drugs may be used. In some cases, limb profusion, a special way for giving more focused dose of chemotherapy may be done.
Radiation Therapy: not used as main sarcoma treatment, but can be used before surgery for shrinking the tumor or after surgery for destroying remaining cancer cells.
Proton Therapy: gives high doses of radiation directly to tumor site and spares nearby healthy tissue and vital organs.
Post-Treatment plan
Talking with health care provider is essential to develop a follow-up care plan. The plan may include:
Regular physical examinations and/or medical tests to monitor the recovery and possible tumor recurrence if any.
Learning ways to prevent or manage side effects, if undergone radiation therapy for treating sarcomas where region of the body may be at risk for limb swelling (lymphedema), fracture of the thigh or leg bones, poor joint mobility and hardness of the soft tissues (fibrosis).
Rehabilitation program (such as range-of-motion exercises, strengthening exercises, and lymphedema reduction exercise) post surgery or radiation therapy for regaining or maintaining limb function.
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You may never know what results come from your action, but it you do nothing there will be no results.
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