Up to 40% of women with breast cancer must undergo repeat procedures to remove cancerous cells that were missed during the first operation. This is due to a lack of  three-dimensional data.

But now a team of mechanical engineers and pathologists have invented a microscope that could potentially assist surgeons to remove breast tumours completely.

The microscope, developed by scientists and engineers at the University of Washington

Health24 previously reported that in some women with breast cancer, taking soy protein supplements boosted the expression of tumour genes associated with an increase in tumour cells.

When removing a breast tumour, known as a lumpectomy, surgeons attempt to remove the cancer but spare as much healthy tissue as possible. But it may take several days after surgery before lab results reveal if the lumpectomy was successful or if additional surgery is needed to remove cancerous cells that were missed, the study’s authors explained.

Part of the tumour left behind

“Surgeons are sort of flying blind during these breast-conserving surgeries. Oftentimes they’ve left some tumour behind which they don’t know about until a few days later when the pathologist finds it,” said mechanical engineering professor Jonathan Liu in a university news release.

“If we can rapidly image the entire surface or margin of the excised tissue during the procedure, we can tell them if they still have tumour left in the body or not. And that would be a huge benefit to cancer patients.”

The newly designed microscope uses a sheet of light to visually “slice” through and image a tissue sample without destroying any of it. This ensures all the tissue is preserved for further testing, which can help doctors learn more about the cancer and determine the best course of treatment, according to the study published in the journal Nature Biomedical Engineering.

Microscopic precision

“If we can do this without consuming any tissue, so much the better,” said co-author Dr Larry True, a professor of pathology at UW Medicine. “We want to use that valuable tissue for purposes which are becoming ever more important for treating patients such as sequencing the tumour cells and finding genetic abnormalities that we can target with specific drugs and other precision medicine techniques.”

“The tools we use in pathology have changed little over the past century,” said study co-author Dr Nicholas Reder, chief resident and clinical research fellow in UW Medicine’s Department of Pathology in the news release.

“This light-sheet microscope represents a major advance for pathology and cancer patients, allowing us to examine tissue in minutes rather than days and to view it in three dimensions instead of two, which will ultimately lead to improved clinical care.”

Read more:

Pituitary cancer

Allergies lower brain tumour risk

Cancer therapy named breakthrough of the year

Crippling stomach cramps, diarrhoea or constipation and an intolerance to certain foods can turn any dining experience or social event involving food and drinks into a nightmare.

Luckily there are tips to improve your dining experience when suffering from IBS (irritable bowel syndrome).

IBS  is the term used for a spastic colon. According to Health24, the common symptoms of IBS are:

• Excessive gas 
• Bloating
• Pain in the lower abdomen
• Nausea
• A change in bowel movements (diarrhoea or constipation), which often brings a sense of relief to abdominal pain

There are several causes of IBS, which can be aggravated by foods containing FODMAPs, an acronym that stands for “fermentable oligo-, di-, mono-saccharides and polyols”. This basically means certain foods such as dairy products, legumes and fruit. Not everyone with IBS is FODMAP intolerant, but it is certainly common. To lessen symptoms of IBS, nutritionists advise patients to eliminate FODMAPs from their diet.

1. Plan ahead

If you are invited to a restaurant, research the menu online for meal options. Check out the gluten-free options on the menu. At a steakhouse, it’s easy  to order a wheat-free, dairy-free (which is known to trigger symptoms) options such as a portion of grilled meat with a side of veggies or salad. If you do have special requests, call ahead and explain your dietary preferences. Most restaurants will be happy to adapt a meal for you.

2. Treat the symptoms

If you know what to expect, lessen your symptoms with over-the-counter remedies. If you know you are prone to diarrhoea, have medicine at hand to treat this. That way, you can be prepared if your symptoms appear when you are out. 

3. Steer clear of the sauces

IBS-triggering FODMAPS are often hidden in sauces and condiments. If a portion of meat is marinated, ask the waiter if the chef can prepare your meat without the marinade. Stick to olive oil and lemon juice to add flavour to your salads. 

4. Locate the restroom

Scout the venue beforehand to know where the restroom is located. That way, you can relax and know where to go once your stomach starts acting up.

5. Drink smart

Alcohol, caffeine and dairy products are the worst culprits for triggering IBS. Stick to drinks you are comfortable with. Drink plenty of water throughout the night to keep the bloat at bay. Although some alcoholic beverages are more likely to trigger IBS than others, people react differently to different beverages. Stick to what you know. 

6. Have an exit strategy

If you know your symptoms will flare up, arrange your own transport or inform your partner so that you can leave the party or event whenever you start feeling uncomfortable. 

7. Focus on the company

Breathe, relax and enjoy the presence of the people surrounding you. Don’t make the event all about the food, but rather focus on the conversation and the company.

Read more:

Beating IBS with the low fodmap diet

Do you suffer from IBS?

IBS changes brain structure

Marelize Wilke

In partnership with Skin Renewal

As discussed in 5 possible causes of pigmentation problems, the type of pigmentation – and whether it’s superficial (epidermal) or deep-seated (dermal), or even both – determines how this common and distressing problem should be treated.

The aim of all treatments is to break down and remove existing pigmentation and to prevent new pigmentation forming. How they achieve this, however, differs in the techniques used, intensity of treatment and also the cost of treatment.

First line of defence: Superficial options

Using a safe and effective cosmeceutical skin treatment is your most accessible option, and will often be used alongside any other form of treatment, as well as for aftercare.

NeoStrata’s Enlighten range is a complete skincare routine – from cleanser to serum – which work together to provide lasting brightening and skin tone evening-out results. The dermatologist-recommended range uses advanced ingredients to tackle the various causes of hyperpigmentation.

The star product, Enlighten Illuminating Serum contains 12 active brighteners (both patented and clinically proven) that target 6 pigment control systems to help break up and reduce the appearance of existing pigmentation and discourage new spots forming.

Obagi Medical’s Nu-Derm Fx system penetrates the skin’s surface to correct the damage within, zeroing in on age spots, hyperpigmentation, skin yellowing and redness, as well as roughness. Available in systems for Normal to Dry and Normal to Oily skin, Obagi Nu-Derm is so effective because of the active ingredient,  Arbutin which is present in a 7% concentration. This natural Hydroquinone derivative extracted from bearberries is a very powerful lightening agent that helps to eliminate and fade thoseunwanted dark marks.

Sun protection is your absolute essential when dealing with hyperpigmentation. You will find the superior sunscreen solutions you need on the Online Skin Care Shop.  

Second Line: Getting under your skin

When dealing withPost-Inflammatory Hyperpigmentation on skin that has been physically damaged or inflamed by disorders like acne, you probably need a combined strategy of skincare, peels and/or injectables:

NeoStrata ProSystem Free-Glycolic Peel is a medical system of peels that can only be used under the supervision of an aesthetic doctor.

NeoStrata, pioneers in AHA and the use of glycolic acid, have devised a system of glycolic acid peels that vary in strength from 20% to 70% – the appropriate strength is used to suit your skin. The peel works to thin out the outer most layer of skin and plump up the living layers of the epidermis. This helps even out skin tone and pigmentation and decreases fine lines and wrinkles. It is perfect for all skin tones and skin types, including sensitive skin. Usually a course of 4 – 6 peels spaced 4 weeks apart is recommended to see a clinical result or outcome.

The other option (which can be used alongside peels) is injectables such as Mesotherapy. Used correctly, tiny amounts of active ingredient (in this case pigmentation-busting TA) are delivered directly into the mesoderm (middle layer of skin) by micro injections to target hyperpigmentation. For needle-phobes, transdermal mesotherapy, where the ingredients are pushed in to the skin with current rather than needles, is also an option.

The third line: Bring out the big guns

For severe pigmentation or dermal pigmentation (or if you have superficial pigmentation but no budget restrictions), treatments such as the Platelet Rich Plasma (vampire facial), lasers such as the Fraxel DUAL and lights have the ability to reach the deepest layers of the dermis, addressing pigmentation issues at the deepest levels.

The Fraxel™ DUAL incorporates 2 lasers in 1: the original 1550nm Restore wavelength targets skin texture and improves deep lines and acne scars, while the addition of the 1927 Thulium laser ensures that all forms of pigmentation can be treated. This gentle, FDA-approved treatment resurfaces the skin from the inside out, showing dramatic results in the treatment of sun damage and pigmentation with hardly any downtime. 

Dr. Maureen Allem, founder of Skin Renewal says: “It is quite a challenge to try and sort out all your ageing concerns in the same treatment session, but every so often, aesthetic technology leaps ahead and gives us a gem like the Fraxel™ DUAL.”

The two lasers can be used together or separately, and shows results in as little as 2-3 treatments.

Other light therapies that work effectively to treat dark pigmentation marks include: 

Laser Genesis award-winning, non-invasive light therapy that effectively treats dark marks, uneven texture and blemishes without pain or downtime.
Limelight non-invasive IPL specifically for brown and red marks, 
Photo Genesis the super-safe, next-generation IPL photo rejuvenation,
Pearl rejuvenation laser, which gives you very targeted skin resurfacing, without weeping skin or significant downtime. Suitable for fair to medium-depth complexions.

Visit the skin experts at Skin Renewal branches to identify your type of pigmentation and discover your treatment options both in salon an at home. Find out more at www.skinrenewal.co.za and on the Online Skin Shop

Wallpaper might give a new lease of life to a dull room, but did you know that there might be toxins lurking behind your wallpaper? In fact, wallpaper may contribute to “sick building syndrome”, a new study suggests.

Sick building syndrome is the name given to the phenomenon when people who regularly occupy a building (like office workers) experience different symptoms whenever they spend time in the building.

Toxins from fungus growing on wallpaper can easily become airborne and pose an indoor health risk, the researchers said.

How can wallpaper be toxic?

In laboratory tests, “we demonstrated that mycotoxins could be transferred from a mouldy material to air, under conditions that may be encountered in buildings,” said study corresponding author Dr Jean-Denis Bailly.

“Thus, mycotoxins can be inhaled and should be investigated as parameters of indoor air quality, especially in homes with visible fungal contamination,” added Bailly, a professor of food hygiene at the National Veterinary School of Toulouse, France.

Many different symptoms

The symptoms of sick building syndrome are similar to flu and allergies, and may include headaches, burning or itching eyes, stuffy nose, sneezing, coughing, sore throat, tight chest, dry or itchy skin, dizziness, difficulty concentrating, nausea and fatigue. People prone to asthma or allergies may find that their usual symptoms worsen while they’re in a certain building. 

For the study, the researchers simulated airflow over a piece of wallpaper contaminated with three species of fungus often found indoors.

“Most of the airborne toxins are likely to be located on fungal spores, but we also demonstrated that part of the toxic load was found on very small particles – dust or tiny fragments of wallpaper, that could be easily inhaled,” said Bailly.

Favourable conditions for fungal growth

Mycotoxins are better known for their occurrence in food. But “the presence of mycotoxins in indoors should be taken into consideration as an important parameter of air quality,” he said.

The study was published in Applied and Environmental Microbiology, a journal of the American Society for Microbiology. Creating an increasingly energy-efficient home may aggravate the problem, Bailly and his colleagues said.

Such homes “are strongly isolated from the outside to save energy”, but various water-using appliances such as coffee makers “could lead to favourable conditions for fungal growth”, Bailly explained in a society news release.

Apart from wallpaper, sick building syndrome can also be caused by:

• Poorly maintained air conditioning systems
• Indoor chemical pollution from cleaning agents, varnish on office furniture etc. 
• Mould and bacteria in damp areas such as leaky pipes 
• Poor ventilation 

Read more:

Sick office syndrome

5 causes of office squabbles

Workplace not as safe as it can be

Biologics are a new kind of medicine, not produced chemically, but made from a variety of natural resources.

Biologics are complex proteins and biotechnology is used to make them. To put it very simply, the process involves getting living cells to make proteins, and this is not only complicated, but also often not successful. They are not chemically produced in a laboratory, as many other medicines are.

What are biologics used for?

Biologics can be used to treat conditions for which other treatments are not available. In different forms, biological medicines have been around for a long time: insulin treatment and certain vaccines fall into this category. Biologics are used more and more often these days to treat non-communicable diseases, which are more widespread.

For some people with complex and rare diseases (as well as some not-so-rare diseases) biologic drugs from the last decade or so are a last refuge of hope. Some of the most baffling diseases, such as cancer and autoimmune diseases, are best treated with biologics. But the high cost associated with them is currently in the news, as the vast majority of South Africans are unable to access these medicines.

For women with a specific form of breast cancer (HER2 positive), a 12-month course of the biologic medicine Herceptin (as it is called in SA) can cost close to R500 000 per year. The biologic medicine for rheumatoid arthritis is called Enbrel, and can costs R4 800 – R9 404 per injection, depending on the strength needed.

Your medical scheme and biologics

Clearly, most South Africans will not be able to pay for this, and many medical schemes are also unable to afford these medicines for their members. But if the condition you have is a prescribed minimum benefit (PMB), and there is no alternative treatment available, the scheme will have to foot the bill. The state hospitals are bound by the same rules. 

This could have a serious effect on other members, as payment for these medicines could deplete the reserves of the scheme. When PMBs were introduced (with the Medical Schemes Act of 1998), high-cost biologic medicines were not yet freely available, and the knock-on effect of their high cost therefore not considered when passing the legislation. 

More and more schemes are now introducing a separate benefit for biologic medicines, but before these are paid for by any scheme, very specific clinical guidelines are followed. The proven efficacy of the medicine for the particular condition being treated, as well as the availability of treatment alternatives are considered before the green light is given. 

Mediscor, a managed healthcare company that manages the medicines claims for 32 medical schemes, said that their expenditure on biologic medicines rose by 29.7% between 2010 and 2015. Cytostatics, a type of cancer medicine, accounted for 6.7% of the medical expenditure in 2015, but only 0.3% of the total items claimed.

The ethical issues

A debate has been raging in the press on the high cost of these biologic medicines, with consumer organisations blaming pharmaceutical companies for being greedy, and putting effective treatment beyond the reach of people who need it.

The pharmaceutical companies cite the high development and research costs in their defence. They are, after all, businesses. These issues are not new to South Africans – for many years the high cost of ARVs put these beyond the reach of millions of South Africans who were HIV-positive. It raises the ethical issue of putting a cost on someone’s life – a debate that has been ongoing for centuries. The following ethical questions have arisen:

What role do patent laws play in the high cost of these drugs?

Generally, a patent on a medicine developed by a pharmaceutical company is held by the company for 15–20 years, after which these medicines may be “copied” and sold by other pharmaceutical companies, who pay the originator companies a license fee. These “copied” medicines are called generics and are equivalent in dosage and strength and performance to the original medicine. As the second company did not have to carry the research and marketing costs, they can afford to manufacture and sell the medicine at a much lower cost.

Why are biologics so expensive?

There are a few reasons for the high cost of biologic medicines. The research and development costs are extremely high and the testing and manufacturing process is lengthy and complicated. There are eight stages to developing a new medicine from start to finish, and, only one in every 5 000 new medicines make it through from discovery to licensing, says Roberto Solari, a senior research fellow at the Imperial College in London.

This process takes years and costs billions. Unlike medicines made from chemical compounds, biologic medicines are made from natural resources and the failure rate of the manufacturing process is high. Many biologics also target rare diseases, so the market for them is small.

Are there generics available for these drugs?

Generic medicines are bioequivalents for originator drugs – in other words, they have the same active ingredients, and work in the same way. Because of the complicated manufacturing process of biologics, they are difficult to replicate. Once a patent expires, other companies can make what is called “biosimilars” which are generally much cheaper than the original biologics, but they are still relatively expensive to produce.

How are the prices of medicines determined in SA?

International drug patents are applicable everywhere. Apart from those, South Africa has a single exit price (SEP) mechanism in place which determines the maximum price at which medication may be sold. Dispensing fees pharmacies can charge are determined by the SEP. In practice, this means that everyone (the state as well) pays the same for particular medicines – and that includes biologics medicines.

More and more non-communicable diseases (NCDs) such as arthritis, diabetes and heart disease can now be treated with biologics. With four of the top ten leading causes of death in SA being NCDs, the debate on the high cost of biologic medicine, and how this can be reduced, will clearly not be over anytime soon.

Read more:

Biologics and breast cancer

Difference between small chemical products and biologics

Biologics not a cure-all, says scheme

Susan Erasmus