Tag Archives: medical writings

Accuracy Amplified: AI Tools Transforming QC Processes in Medical Publications

Medical Writing,

In the field of medical publishing, accuracy and precision are crucial. Medical writers and editors ensure accuracy, clarity, consistency, and error-free information in publications. This task has traditionally been time-consuming and prone to human error. However, with the advent of AI technology, powerful tools to enhance quality control (QC) and copy-editing processes. In this blog, we’ll explore how AI is revolutionizing these crucial aspects of medical publication.

The Challenges of Quality Control and Copy Editing in Medical Publishing

The challenges we face in QC and copy editing for medical publications are varied and can roughly be summed up as:

  1. Volume and Complexity: Medical literature often involves large volumes of complex information, making thorough review a daunting task.
  2. Consistency: Maintaining consistency across multiple documents or within large documents can be challenging, especially when multiple authors or editors are involved.
  3. Technical Accuracy: Ensuring the accuracy of medical terminology, drug names, and statistical data requires specialized knowledge and attention to detail.
  4. Style Adherence: Different publications may have specific style guidelines that need to be consistently applied.
  5. Time Constraints: Tight deadlines can put pressure on the QC and editing process, increasing the risk of overlooked errors.
  6. Cognitive Fatigue: Extended periods of detailed review can lead to mental fatigue, potentially resulting in missed errors.

How AI is Transforming QC and Copy Editing

AI-powered tools have proven to be useful in addressing these challenges, offering solutions that enhance accuracy, efficiency, and consistency in the QC and copy-editing process. Here are some key areas where AI is making a significant impact:

  • Automated Proofreading and Grammar Checking

Advanced AI-powered proofreading tools go beyond basic spell-check functionality. They can identify complex grammatical errors, suggest improvements in sentence structure, and even detect nuances in tone and style. For medical writing, these tools can be customized to recognize field-specific terminology and conventions.

Example: Tools like Grammarly or ProWritingAid, when tailored for medical content, can catch errors that might slip past human editors, especially in long documents.

  • Consistency Checking

AI can quickly scan entire documents or sets of documents to ensure consistency in terminology, formatting, and style. This is particularly useful for maintaining uniformity across multi-author papers or large clinical trial reports.

Example: An AI tool could flag inconsistencies in the spelling of drug names (e.g., “paracetamol” vs. “acetaminophen”) or variations in formatting of statistical data across a document.

  • Reference and Citation Verification

AI-powered reference management tools can automatically check the accuracy and formatting of citations and references. They can also flag potential issues like outdated sources or mismatched citations.

Example: Tools like EndNote or Mendeley now incorporate AI features to suggest relevant citations, check for formatting consistency, and even detect potential citation errors.

  • Plagiarism Detection

While not unique to medical publishing, advanced AI-driven plagiarism detection tools are crucial for maintaining the integrity of scientific literature. These tools can identify not just verbatim copying but also paraphrased content and idea similarity.

Example: iThenticate, a widely used plagiarism detection tool in academic publishing, uses AI to compare submitted manuscripts against a vast database of scientific literature.

  • Technical Accuracy Checking

Specialized AI tools are being developed to verify the accuracy of medical and scientific content. These can check for correct usage of medical terminology, accuracy of drug dosages, and consistency of statistical reporting.

Example: A hypothetical AI tool could cross-reference drug names and dosages mentioned in a manuscript against established pharmacological databases to flag potential errors or inconsistencies.

  • Style Guide Compliance

AI can be trained on specific style guides (e.g., AMA, APA) to ensure that documents adhere to the required formatting and stylistic conventions.

Example: An AI tool could automatically check and correct formatting of headings, tables, and references according to the target journal’s style guide.

  • Readability Analysis

AI-powered readability tools can analyze the complexity of the text and suggest simplifications where necessary. This is particularly useful for patient-facing materials or when aiming for clear communication of complex medical concepts.

Example: Tools like Hemingway Editor use AI to suggest ways to make prose clearer and more concise, which can be invaluable for improving the readability of dense medical text.

  • Data Consistency and Accuracy Checking

For publications involving large datasets or multiple statistical analyses, AI can verify the consistency and accuracy of reported numbers across text, tables, and figures.

Example: An AI tool could cross-check numerical data in the results section against data presented in tables and figures, flagging any discrepancies for human review.

  • Language Translation and Localization

For medical publications that require translation, AI-powered translation tools, when used under human oversight, can significantly speed up the process while maintaining accuracy.

Example: DeepL, an AI translation tool, has shown promising results in accurately translating medical texts, though human review remains essential.

Implementing AI in the QC and Copy-editing workflow

While AI tools offer tremendous potential, their effective implementation requires careful consideration:

Challenges and Limitations

While AI offers significant benefits, it’s important to be aware of its limitations:

  1. Context Understanding: AI may struggle with nuanced context or highly specialized content. Human expertise remains crucial for interpreting and validating AI suggestions.
  2. Over-reliance: There’s a risk of becoming overly dependent on AI tools, potentially leading to complacency in human review.
  3. Learning Curve: Integrating AI tools into existing workflows requires time and may initially slow down processes before improving efficiency.
  4. Cost: Advanced AI tools can be expensive, potentially limiting access for smaller organizations or individual freelancers.
  5. Data Privacy: When using cloud-based AI tools, ensure they comply with data protection regulations, especially when handling sensitive medical information.

The Future of AI in Medical Publication QC and Editing

As AI technology continues to evolve, we can expect even more advanced capabilities:

  • Predictive Editing: AI might suggest edits based on patterns in previous publications or author preferences.
  • Real-time Collaboration: AI could facilitate real-time editing and QC in collaborative environments, flagging potential issues as content is being created.
  • Automated Fact-Checking: Advanced AI might cross-reference claims in manuscripts against current medical literature to flag potential inaccuracies or outdated information.
  • Enhanced Contextual Understanding: Future AI may better understand complex medical contexts, reducing false positives and improving suggestion relevance.

AI technology is revolutionizing quality control and copy editing in medical publishing. By leveraging these tools, we can significantly enhance the accuracy, consistency, and efficiency of our work. However, it’s crucial to remember that AI is a powerful assistant, not a replacement for human expertise. The most effective approach is to combine the strengths of AI – speed, consistency, and the ability to process vast amounts of data – with the nuanced understanding, contextual knowledge, and critical thinking of human medical writers and editors.

As we move forward, embracing and adapting to these AI technologies will be key to maintaining the highest standards in medical publishing. By doing so, we can focus more of our human efforts on the aspects of our work that truly require our unique insights and expertise, ultimately leading to higher-quality medical publications and, by exten

Sexual and Reproductive Health Awareness

Health & Fitness,

February 12 is declared as Sexual and Reproductive Health Awareness Day annually. This day provides an opportunity to raise awareness about sexual and reproductive health issues and educate to reduce the spread of sexually transmitted infections (STIs). STIs are one of the major public health concerns. Hence,

Sexual and Reproductive Health Awareness Day is therefore an annual health promotion event which focuses on the importance of sexual health issues. Also these health awareness events create publicity for health issues and aims to improve the condition and help save lives, sometimes these events encourage preventative action against conditions becoming more serious.

Sexual health is a broad area that encompasses many inter-related challenges and problems. Key issues and concerns are human rights related to sexual health, sexual pleasure, eroticism and sexual satisfaction, diseases (HIV/AIDS, STIs, RTIs [reproductive tract infections]), violence, female genital mutilation, sexual dysfunction and mental health related to sexual health.

The objectives of this awareness include:

  • Improving the acceptability of safer sex behavior;
  • Decreasing the prevalence of STIs within the community;
  • Providing sexual health information, education and resources ; and
  • Improving health seeking behaviour to increase testing and treatment for STIs.

The goal of having an awareness week is to encourage people to consider the importance of maintaining reproductive health and talking about healthy decision-making with the people they care about.

 

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Screening tests may help find diseases or conditions early when they are easier to treat. It is also important that each of us is aware of our own bodies so if changes occur that don’t seem normal they can be checked by a health-care provider.

 

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The National Population Stabilisation Fund (Jansankhya Sthirata Kosh) has started a helpline to provide confidential counseling services and immediate answers to queries on sexual and reproductive health problems. For authentic telephonic information on Reproductive Health, Family Planning and Infant Health, Call 1800-11-6555. This helpline operates daily from 9am to 11pm. A team of health executives and doctors answer questions about sexual health concerns, sexually transmitted infections, contraception, pregnancy, infertility, abortions, menopause and puberty and can explain the functioning of the reproductive systems of males and females.

The helpline will also work towards removing popular misconceptions about sex, important in a country such as India where the subject is still socially taboo. When experimented with in schools, confidential information services have been shown to be in high demand. They can help in providing objective advice from a respected source rather than peers, the Internet and word of mouth, increase public knowledge of their rights and trust in public facilities, and can reduce the bridge between users and services.

Education can provide the social vaccine needed, offering a real chance at a productive life. Not only is education essential for preventing HIV, preventing HIV is essential for education.

 

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#WorldHeartDay

Awareness Day/Month, , , ,

“A heart for life”

World Heart Day (sponsored by World Heart Federation) was founded in 2000, a biggest intervention against cardiovascular disease (CVD) which takes place on 29 September every year. Around the globe, heart disease and stroke constitutes 17.3 million deaths every year.

The main focus of this is on creating healthy heart environments. By ensuring that everyone has the chance to make healthy heart choices wherever they live, work and play. World Heart Day encourages everyone to reduce our cardiovascular risk, and promotes a heart-healthy planet for those around us.

Each year there is a different theme for World heart day which essentially concentrates on the key issues and topics relating to heart health. This year’s theme is to ‘create heart-healthy environments’.

World Heart Day spreads the news that at least 80% of premature deaths from CVD can be avoided by four main risk factors- tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled. The magnitude of the benefits that can be achieved by reducing these risks makes intervention cost-effective. Hence there is a need to designate a special day for activities to prevent heart disease and stroke.

Creating a heart healthy environment,

  • Promoting physical activity, such as trails for walking, running, bicycling and places for playing outdoor games.
  • Schools and child care facilities that provide quality physical education and have nutritious meals available.
  • Workplaces and community spaces that are smoke-free and have healthy food options.

World Heart Day is observed in many different ways across the world. Many innovative ways have been devised by several foundations and professional societies for marking this event. There has been an association between national societies and foundations in many countries. These include runs, sports events, theatre, street events, dancing, and cycling in public spaces, schools, and hospitals. The success of this depends on the proactivity of organizations from around the world to help us spread awareness of CVD.

World Heart Day has enjoyed huge success in building partnerships by obtaining support from the private sector, charities, societies and foundations for this common cause. The next step is to engage the public sector and foster collaboration with the Ministries of Health. An active participation of WHO has already been done in the World Heart Day campaign.

This World Heart Day is an ideal opportunity to scale up efforts at the country level within a globally led initiative. A whole day dedicated to CVD prevention is an effective way of engaging the media, the public, policy-makers, and health professionals in information dissemination, awareness creation, and advocacy.

Turacoz Healthcare Solutions as a socially responsible company spreads the word and awareness and looks forward to collaboration or associations with other agencies/companies with similar goals and aspirations. We have a skilled and competent team of medical writers, clinicians, researchers and biostatisticians. Our clients include major pharmaceutical companies, hospitals and healthcare professionals. Our experience has been in supporting publications, creating regulatory documents, conducting observational studies, designing and creating for print and digital marketing as well as customizing sessions on medical writing.

#PsoriasisAwarenessMonth: Management and prevention

Awareness Day/Month, , , ,

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.

Over-the-counter topical medications include, salicylic acid foams or ointments, Coal tar, Zinc pyrithione.

  • UVB is a safe, effective and cost-effective.
  • 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).

Turacoz supports #SarcomaAwarenessMonth: Do not loose hope

Awareness Day/Month, , , , ,

 “Once you choose hope, anything’s possible.”

Christopher Reeve

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.

The sarcoma center in India “Soft Tissue Tumor Online http://www.histopathology-india.net/SoftTissuePath.htm”

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.

 

Beat Sarcoma beatsarcoma.org
Cure for Sarcoma http://www.cureforsarcoma.com/
Cynthia Solomon Holmes Foundation http://www.cynthiaholmesfoundation.com/
Dani’s Foundation www.danisfoundation.org
Desmoid Tumor Research Foundation dtrf.org
GIST Support International gistsupport.org
H. Lee Moffitt Cancer Center in Tampa moffitt.org
Kristen Ann Carr Fund www.sarcoma.com
Liddy Shriver Sarcoma Initiative sarcomahelp.org
The Life Raft Group liferaftgroup.org
LMSarcoma Direct Research http://www.lmsdr.org/
Jared Juggernaut http://jaredsjuggernaut.org/
Northwest Sarcoma Foundation nwsarcoma.org
Sarcoma Alliance http://sarcomaalliance.org/
Sarcoma Alliance for Research through Collaboration (SARC) www.sarctrials.org
Sarcoma Foundation of America www.curesarcoma.org

 

 

Diabetes Management and Ramadan: What does ADA say?

Health & Fitness, , , , ,

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

  1. Frequent monitoring of glycaemia: especially important for patients with type 1 & 2 diabetes requiring insulin.
  1. 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.
  1. 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.
  1. 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
  1. 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.
  1. 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.
  1. 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.
  1. Managing of patients with type 2 diabetes:
  2. 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.
  1. Patients treated with oral agents: choice of oral agents should be individualized.
  2. 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.
  3. 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.
  4. Short-acting insulin secretagogues: could be taken two times daily before the sunset and predawn meals.
  5. 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.
  6. 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.
  7. 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.
  1. 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.
  1. 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.

July is #SarcomaAwarenessMonth: Come Spread the Word

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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:

  1. Age and medical condition
  2. Type of cancer suspected
  3. Severity of symptoms
  4. 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:

  1. Location and type of sarcoma.
  2. Spread of cancer.
  3. Impact on body.
  4. 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.

Turacoz Healthcare Solutions  takes steps in creating awareness and communicating to the society  information on disease-diagnosis, prevention, management and complications because we believe in

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