Brain metastases from systemic cancer are the most common type of intracranial neoplasm in adults, being almost 10 times more common than primary malignant brain tumors, which cause a significant burden on the management of patients with advanced cancer (1). The lungs represent one of the most frequent sources of metastases to the brain, with a probability of (36 64%) (3). Symptoms suffered by the patients include headaches, epilepsy, focal weakness, numbness or changes in mental status. The prognosis of patients with brain metastases is not optimistic and the median survival time is  1 2 months if left untreated. The 1-year survival rate has been recorded as 10.4% (4,5). The treatment of metastatic brain tumors is complex; not only due to being able to provide local control and improve neurological function, but also due to factors such as age, performance and systemic disease status and the size, volume, location and number of metastases at presentation

CyberKnife is a robotic radiosurgery system with a linear particle accelerator (linac), which is coupled with real-time imaging to track and compensate for the patient s or target s motion. As a relatively non-invasive treatment modality, CyberKnife demonstrates certain benefits, including a more accurate target localization and improved dose delivery for the management of metastatic brain tumors that allows higher biologically effective dose delivery without increased incidence of toxicity.

In the present case, the results for the treatment of multiple brain metastases after CyberKnife surgery with a 7 8 Gy marginal dose was promising. CyberKnife for metastatic brain tumors is an effective and safe method for reducing the marginal dose prescribed for multiple brain metastases and for minimizing the radiation-related neurotoxicities. In conclusion, CyberKnife, a focused, highly-targeted radiosurgery and fractionated radiotherapy is particularly useful for multiple brain metastases. CyberKnife provides the advantage of the management of local recurrence and a tolerable complication rate. Although the treatment of brain metastases has been performed with CyberKnife, the clinical significance and optimal dose fractionation scheme require further investigation.

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CyberKnife Therapy Of 24 Multiple Brain Metastases From Lung Cancer!

Tuberculosis is an opportunistic infection caused by the bacteria Mycobacterium tuberculosis. The infections occurring in people with weak immunity as compared to the people with a healthy immune system are called as opportunistic infections. As, HIV enters the human body, it replicates and weakens the immune system which in turn increases the risk of contracting Tuberculosis in people already suffering from HIV infection.

An HIV and Tuberculosis co-infection occurs when an individual has both, the HIV infection and an either latent or active TB disease simultaneously.  Each disease acts in speeding up the progress of the other, when HIV and TB infection is present together in the body. HIV infection speeds up the progression from latent to active Tuberculosis, Mycobacterium tuberculosis also accelerates the progression of replication and spread of the HIV infection.

HIV infection and Tuberculosis are totally different type of infectious diseases. HIV is a viral infection and TB is a bacterial one. An HIV infected person will not contract TB unless a contact happens with a TB infected person. TB spreads via droplet infection and is communicable. If a person lives in a country with a high prevalence rate of TB, an HIV patient is highly susceptible to contracting the infection. In the similar manner, a person suffering from TB gets infected with the HIV infection only through the blood and bodily fluids borne route, with unprotected sexual intercourse with an HIV infected individual being the most important cause.

Amongst all the other opportunistic infections, TB occurs at an earlier stage in the course of an HIV infection than most other opportunistic infections. Mortality rate in the co-infected patients is more than twice that of HIV infected individuals without a TB infection. Even if a patient is undergoing anti-retroviral therapy, the death rates remain high in co-infected individuals.The natural history and course of TB gets altered in people with an infected immune system. The damage to immunity due to HIV infection causes a drastic reduction in the pathogen killing capacity of the body. In such patients if there is no anti-retroviral treatment prescribed, then the latency period between the infection and progression of disease gets eliminated. 

An active phase of TB is observed in such individuals progressing within a short span of time, ranging from weeks to months, rather than years as it normally should be spanning. Risk of progression from a latent stage to an active stage of TB is around 10-15 times greater in an HIV infected individual as compared to the non-infected person. Such individuals also communicate the disease more rapidly to others.Pulmonary tuberculosis in an HIV infected person can present similar symptoms like that of a classic TB disease. However, a co-infection can sometimes show less presenting TB symptoms, where even the chest X-ray scans can be observed to be normal. A  subclinical  phase of Tb in co-infected patients can cause delay in the diagnosis of the symptoms and subsequently affect the prognosis due to lack of timely treatment.

Social stigma and discrimination has caused an obstacle in provision of adequate treatment for people with HIV. Proper counseling  and initiatives taken to provide indiscriminate care can aid in identification of co-infection and earlier stages. Anti-retroviral treatment teamed up with anti-tubercular drug regimen is prescribed and a successful treatment for drug sensitive cases of TB can be provided with medications for 6-8 months.

How HIV & TB  Are Related?

Without our lungs, it would be impossible to breathe. People suffering from chronic lung diseases have compromised lung functioning. This leads to shortness of breath, fatigue and weakness. In turn, this can make the person avoid anything that exerts the lungs such as exercise. While this may seem like a good idea, it is actually detrimental. Not exercising can further weaken the lungs and muscles and make this a vicious cycle. This is where physiotherapy can help with lung rehabilitation or pulmonary rehabilitation.

Physiotherapy is a branch of medicine that treats diseases and health conditions with exercise and manual therapy. Physiotherapists may also use radiation, sound waves, electric therapy, prosthesis and assistive devices. The aim here is not to cure the disease but to improve lung functioning and the patient s quality of life. Pulmonary rehabilitation can help in a number of ways.

It reduces breathlessness: As the lung muscles weaken, their ability to pump oxygen and transport it to the other parts of the body reduces. This can make a person feel breathless even with the slightest exertion. Lung rehabilitation works on strengthening the lung muscles to reduce this breathlessness.
It increases muscle strength in the arms and legs: When oxygen does not reach the limbs, they, in turn, get weaker. By strengthening the lungs, lung rehabilitation increases the muscle strength in the patient s arms and legs.
It increases stamina and endurance: Stamina is directly linked to lung functioning. By helping the patient breathe more comfortably, lung rehabilitation increases the patient s stamina and helps him or her endure more physical exercise.
It helps patients understand your condition: Physiotherapy is part exercise and part education. By helping patients get an insight into their condition, physiotherapy helps them come to terms with their limitations and motivates them to work harder towards overcoming them.
It increases self-confidence: Feeling breathless and tired all the time can make people feel frustrated. This is especially so because these things cannot be controlled without help. Physiotherapy teaches patients how to deal with these issues and thus increases their confidence in dealing with their medical issues.
It makes patients more independent: A lack of energy can make people dependent on others. Even simple tasks like getting a bottle of water from the fridge can seem like a tiring task. Physiotherapy improves lung functioning and hence makes the person feel less tired doing everyday tasks. This makes the person more independent and improves their quality of life.

Lung Rehabilitation With Physiotherapy!

Tuberculosis or TB is an airborne disease that mainly affects the lungs and has the potential to be fatal. People with an impaired immune system such as newborn babies, pregnant women or women who have just delivered a baby, diabetics, cancer patients and HIV positive people are at the highest risk of suffering from this disease. However, this disease can be prevented and treated.

Here are a few ways to protect yourself from this bacterial infection.

Keep your distance: TB is a communicable disease and hence can spread from one person to another. If someone around you suffers from this disease, try limiting your contact with them. In cases where this is not possible, wear protective gloves and a mask to keep yourself safe. Avoid crowded, unhygienic places and always wash your hands with a disinfectant after contact with a TB patient.
Boost your immunity: A strong immune system can fight off TB bacteria and keep you from getting infected. To build a strong immune system, eat plenty of fresh fruits and vegetables along with the required amount so carbohydrates, proteins and fats every day. Along with this, consult your doctor and start taking multivitamins or antioxidants on a daily basis.
Maintain proper hygiene: Keeping your surroundings clean are crucial to the prevention of tuberculosis. Ensure that not only your home is kept clean, but the surrounding area is cleaned as well. Do not allow garbage to accumulate around your house. Make it a habit of washing your hands with disinfectant soap every time you come home and before eating anything.
Vaccinate your children: When getting your children vaccinated, ensure that your child also receives the BCG or Bacillus Calmette-Guerin vaccine that can protect him or her against TB.
Ventilate the house: The bacteria that causes tuberculosis, thrives in stagnant air and enclosed spaces. Hence, open your windows and let some fresh air in. Not only does this prevent the multiplication of bacteria and viruses in your house, it also does not allow your home to have a musty odour.
Follow the complete course of treatment: If you have been diagnosed with TB, it is essential to complete the full course of antibiotics and not stop midway even if the symptoms have disappeared. Not adhering to the prescription gives the bacteria the ability to develop resistance to the drugs. When this resistant bacteria is exhaled it can infect more people with drug-resistant tuberculosis that is harder to cure.

6 Precautionary Measures You Must Follow In Tuberculosis!

Coughing is a common problem of the respiratory tract and often indicates a deeper problem. It can be very irritating and can affect eating habits and socialization. A cough which persists for more than 4 weeks is believed to be chronic in nature. Tuberculosis (TB) is the most common cause of chronic cough in India. TB is an airborne bacterial infection caused by the organism - 'Mycobacterium tuberculosis', that primarily affects the lungs, although other organs and tissues may be involved. Cardinal features are: 

Chronic cough with or without sputum.
Fever more in the night time. 
Poor appetite. 
Unintentional weight loss. 
Read on to know about other common causes of chronic cough and how to manage them.

Allergies: People with allergies usually have a chronic cough, which gets aggravated when exposed to the allergens such as pollen or environmental dust. Staying away from allergen provides relief. Antihistamines are also useful, which most people detected with allergies keep in handy. Inhalers might be required, if there is associated congestion or shortness of breath.
Asthma: This is a very common chronic condition, caused by inflammation and swelling of the lungs, in addition to wheezing and shortness of breath. Asthma patients often suffer from a chronic cough. An asthma attack usually happens during the night or early morning, and is triggered by colds, cigarette smoke, air pollutants or allergens, which can even include certain foods. Most asthmatics usually carry their steroids, inhalers, and bronchodilators, as the onset of attack can be unpredictable.
Bronchitis: This condition of inflammation of the bronchial region is very common among smokers and among the elderly. There is excessive mucus accumulation, which the body tries to clear via coughing. The lungs are weakened and therefore, the coughing is painful.
Gastroesophageal reflux disease (GERD): This is a problem of the digestive system, but regurgitation of food into the airway induces cough. GERD is a chronic issue and so most people also end up with a chronic cough. It is worse with sitting up than with sitting down. Treatment includes H2 blockers to suppress acid production and dietary changes including small, frequent meals and avoiding spicy food items.
Upper airway cough syndrome: There could be multiple problems in the upper airway, which leads to a constant postnasal drip. Here, there is constant dripping of the sputum into the air passage, which can lead to a chronic cough whenever there is impaired air flow. This can be caused by various forms of chronic sinusitis and rhinitis. People diagnosed with this condition usually resort to antihistamines and decongestants for relief.
Other causes: There are a number of other causes as noted below. Smoking, tuberculosis, congestive heart failure, pertussis or whooping cough, foreign body in the airway, cancer in the airway passage, chronic aspiration of foods, etc. can all lead to chronic cough.
The key is to identify the reason that is causing the chronic cough. Most people who are diagnosed are educated to handle it and carry the required medications including steroids, bronchodilators, and inhalers.

Suffering from Chronic Cough - How to Manage it?

Chronic Obstructive Pulmonary Disease or COPD for short is a respiratory disease that makes it increasingly difficult to breathe; the lungs stop functioning properly. There are mainly two categories of COPD which are emphysema and chronic bronchitis. The primary reason for COPD is longstanding exposure to substances such as cigarette smoke, chemical fumes and air pollutants that damage the lungs gradually.

Initially, the symptoms of COPD may be really mild but over time it may become extremely severe. These include symptoms such as:

Shortness of breath
Coughing with mucous formation
Wheezing or gasping
Tightness in the chest
Feeling tired constantly after doing normal daily activities or after exercising.
In the long run, the damages can prove to be permanent.

Of the two subtypes mentioned, bronchitis is when the airways become inflamed as well as narrowed. People suffering from bronchitis tend to produce sputum which is basically a combination of mucus and saliva.
And the other subtype, Emphysema is the condition when the air sacs in the lungs become affected. The air sacs degenerate and become baggy with lots of holes in it. This, in turn, traps air. This narrows the airways making it difficult to breathe. In COPD, there is a narrowing of the lungs because:

The lining of the airway becomes inflamed
The lining of the airways which is elastic flops
The tissues of the lungs become damaged so there is an exertion on the airway.
COPD, in the long run, can lead to a number of health complications such as heart disorders, lung cancer, respiratory infections, depression and high blood pressure. COPD is treatable but not curable because it is a life-long condition. The following are some of the treatment methods for COPD:

Oxygen Therapy- If you are experiencing low levels of oxygen then opting for a portable oxygen unit will be extremely beneficial.
Medication- Bronchodilators help in relaxing the airway muscles for comfortable breathing. These medications are usually taken via an inhaler. Other medications include corticosteroids, theophylline, vaccines and antibiotics/antivirals.
Surgery- Surgery is usually advised as the last step when the COPD condition has become so severe that all other methods of treatment have failed. This is, more possible, in the case of emphysema. There are mainly two surgical methods: one is bullectomy when the surgeons remove the damaged air sacs. The other method is lung volume reduction which removes the lung tissues that have become damaged.
Adopting certain lifestyle changes can provide relief for the time being. Such alterations include:

Quit smoking immediately, if you haven t already.
Try to avoid passive smoking as much as possible. Passive smoking is as damaging as firsthand smoking.
Give your body the daily dose of nutrition so that the immune system doesn t falter as well.

Better Living with COPD - A Patient Guide!

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