Social Stigma and Behavioral Disorders

Kids absorb like a parched desert during rain. Their minds are in the developmental phase and they constantly acquire general behavioral trends from their immediate surroundings. While most of them might not be able to assign specific logic to what they follow, they grow to understand the reality.

But do all children avail an equal chance at life? Adults frequently fail to understand children with behavioral disorders. At social events, they’re isolated or ignored as the naughty or weird ones. The contemporary situation is very indicative of the fact that the society is not educated about the symptoms of these ailments. These children fail to receive proper treatments.

Why this should be discussed more often

The social stigma towards people who face these disorders doesn’t allow them to get timely and sufficient treatment. This ignorance is felt at both the individual and family level. Lack of proper infrastructure for healthcare in rural areas further hinders the diagnosis and treatment process.

The stigma is also reflected at an institutional level in terms of education and employability. Only an increased awareness will pave way for health care reforms in this specific field.

Some common disorders that go ignored

Autism:

Autism spectrum of disorders is a syndrome that results from any of the plethora of developmental disorders of the immature brain. And there is strict differentiation between autism and the wide range of other psychiatric disorders.

Autism challenges the kid’s social skills. It affects the child’s verbal and non-verbal communication and is characterized by repetitive behavior. With these difficulties, the routine tasks that other people their age perform normally seem much more difficult. They hence acquire a certain level of anxiety. However, autism may not be reflected in the looks of a child and people very often misunderstand them.

Autism remains as a lifelong disability. But no two autistic minds see the world the same way. They thus need different levels of support too.

OCD

OCD or obsessive compulsive disorder is a neurobiological ailment.  It prevails in both children and adults. When a person is affected by OCD, involuntary intrusive thoughts cross his mind often to consume hours each day. To get over this, the affected individuals devise their own compulsions. This causes repetitive behavior. For instance, a fear of something may lead to repetitive and more frequent checks of doors/locks.

OCD is a chronic condition too and has no established treatment.

ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a disorder of the brain characterized by inattention and impulsivity. These kids generally make hasty actions and have difficulty sustaining focus. It hinders their development greatly.

Some cases of ADHD are unrecognized. This is because these children are usually categorized as the notorious ones and the rather severe symptoms of ADHD get overlooked.

Can they be treated?

The Behavioral Disorders drug development pipeline aims at introducing medicines that can manage the symptoms of the ailments. These medications are however not expected to cure the disorder completely. They look to improve focus and reduce impulsivity.

Moreover, these disorders do not have physical symptoms. An early diagnosis thus becomes difficult. Sometimes, the person affected by these disorders might take up to substance abuse. That person becomes an easy suspect and shows symptoms like burnt fingertips, body tremors, and bloodshot eyes.

The enigma of a woman’s body

Understanding the female anatomy

The unfortunate truth is that most women do not understand their body. This keeps them puzzled about the discomforts caused. Only a better understanding will make a better diagnosis be possible. This will further pave way for a better treatment.

The reproductive system is the most complex of all organs functioning in a woman’s body. It has both internal and external parts. The external genitalia; the vulva, vagina, and cervix, are known to be more prone to infections. There is also an increase in the number of cancer cases reported for these organs.

Malignancies in these regions of the body are referred to as lower reproductive cancers. And for every part affected, symptoms differ. 

The lower reproductive cancers

Vulvar cancer

The vulva is not an isolated part. It comprises of the urethral opening, the vaginal opening, the clitoris, the labia and the Mons pubis. Cancer of the vulva is a very common gynecological malignancy and most cases are reported in women of the menopausal age. The risk of developing this disease increases as a woman gets older. But young women are no exception.

HPV or the Human Papilloma virus is the most investigated etiologic agent for vulvar malignancies. HPV-caused cancers of the vulva represent a local spread of the virus from genital warts to the cancerous region. Research also suggests a link between vulvar dystrophy and cancer. This is a medical condition where patchy areas of thickened skin are seen in and around the vulva. These regions of the skin are usually itchy or cause a burning sensation. But there exist minimal possibilities of this condition progressing to cancer. A plethora of other potential risks from the menstrual history and lifestyle factors have been identified. But none of these are known to have a great influence.

Demographics thus suggest two distinguished group of women who develop vulvar cancer.

•    Women above the age of 45-50 who aren’t positive for other infectious diseases

•    Younger women in whom an existing medical condition progresses to cancer or those who are immuno-suppressed

Vulvar cancer is indicated by a change in the color of the skin around the vagina. There may also be rashes in the same region that are sensitive to touch.

Vaginal cancer

The vagina is a connection between the vulva and the uterus. A vaginal cancer is the least common of all gynecologic cancers. A less extensive research about the disease can be attributed to this very fact.

The etiologies are nearly similar to those of a vulvar malignancy. But an important observation is that most women who developed this condition had a hysterectomy performed. The use of synthetic estrogens like DES during pregnancy has also been identified as a potential threat.

Untimely bleeding and abnormal vaginal discharge are the main symptoms of this condition.

Cervical cancer

Cervical cancer follows breast cancer in the number of cases. It can hence be categorized among the most common malignancies.

Tobacco is a major risk factor. Carcinogens from tobacco and an HPV infection (or other STIs) are known to act in synergy to cause this. Sexual behavior, although a risk factor, has not been identified as an independent influence. Research also suggests that the administration of hormonal pills can drive the rate at which cervical cancer progresses. Exacerbated levels of risk for all cancers are seen in immuno-suppressed individuals.

Cervical cancers often go unrecognized because of the lack of visible symptoms. In some cases, there might be abnormal vaginal discharge or bleeding post sexual intercourse.

Diagnosis and treatment

Regular health examinations aid the early diagnosis of these conditions. Symptoms may not necessarily develop at these stages. A pap smear is the sample used for diagnosis of cervical cancers. But no screening tests are available for the others. X-rays, ultrasounds or other imaging systems can check the growth of the tissue.

Reproductive cancers can be treated with surgery, chemotherapy, hormone therapies, and radiation too. Some physicians might even suggest varying combinations of these. But one needs to be informed that reproductive cancers are capable of causing infertility in women.  There has been extensive research going on to resolve this issue. The Lower Female Reproductive System Cancers Drug Development Pipeline is thus ever widening.

Can Medication Now Treat HIV-AIDS?

We usually see the immune system as an isolated system waiting undisturbed for an intruder organism to attack the body. But the reality is that a lot of these potential diseases are eliminated by our immunity and so you never see their symptoms. The immune system constantly produces new cells that patrol your body and monitor the presence of substances that can possibly cause harm to it. These substances are what evoke an immune response.  

All healthcare measures that we take are to maintain an efficient and constantly active immunity. We usually look up to our immune system to protect us from the attacks of pathogens or threats posed by other etiologies. But what happens when the immune system itself is taken over?

Viruses are microscopic creatures that are the tiniest but the most notorious disease causing agents. These organisms are not capable of multiplying on their own. When they cause an infection, they take over the human cell machinery for their spread. This bars the usual functioning of the cells. The Human Immunodeficiency Virus (HIV), a retrovirus, infects key cells of the immune system known as the T-cells. It thus effectively shades itself from other components of the system. A pronounced depletion of immune cells weakens the system. The regular infections that aren’t lethal also burden the patient’s body greatly. The condition is hence referred to as an Acquired Immunodeficiency Syndrome (AIDS).

Clinical management of HIV-AIDS is faced with unprecedented challenges owing to the ability of the virus to evade immune responses. The HIV drug market thus received no boost until recently.

What is all the hype about?

The marketing clearance of Biktarvy, a drug for HIV-AIDS by the US FDA shook the world. It was introduced by Gilead Sciences Inc a bio-pharmaceutical company. Market research reports forecast sales of about one billion dollars for the establishment in the coming year. They also suggest a rise to five times this amount by 2024. 

The company got a much needed boost from this approval after a failed quarter. HCV medication, the company’s flagship product saw a great plummet in its sales. A lost competition with one drug was covered up by a win in another. The company that had forecasted a further slow-down in the sales now expects to grow at a faster pace. It has an upper hand in the HIV drug market because this medication is approved for people who have never taken anti-retroviral drugs and also for people who have been on a similar medication for only 3 months with no failure in treatment. Its contemporaries are approved only for people who’ve been taking similar drugs for at least 6 months and have no adverse effects. Even the subjects of clinical trials showed no treatment-emergent resistance.

How does Biktarvy work?

Biktarvy is also referred to as the ‘triple-drug’ for HIV. Until now, people were using multiple pills to keep the viral count low. But Biktarvy is based on a once-daily single tablet regimen. It is a combination of an integrase inhibitor, bictegravir, and nucleoside reverse transcriptase inhibitors emtricitabine and tenofovir alafenamide. For the HIV to enter the T-cells of the immune system and take charge, integrase and reverse transcriptase are crucial enzymes. They allow it to replicate in the human host. The inhibitors prevent the integration of viral genetic material with the host genome. The infection hence remains under control.

The body’s response to the drug can be measured in terms of viral load or T-cell counts. A decrease in the former and a stability or increase of the latter is indicative of a positive result. Biktarvy works with no food intake regulations and no minimum required counts of the virus.

Is it safe?

Contraindications:

·         The use of Biktarvy during pregnancy has not been studied sufficiently

·         The drug cannot be used along with medications containing dofetilide or rifampin.

Adverse reactions:

Diarrhea, nausea, and headaches were commonly observed side effects during the clinical trials. However, there can be more severe reactions in the body post intake of Biktarvy. Medical conditions of buildup of lactate and abnormal functioning of enzymes and transporters in the body have been reported due to the administration of this drug. These can lead to fatal medical situations.

Worsening existing impairments:

People with renal or hepatic implairments have been advised against the usage of this drug. It is known to exacerbate these issues. Instead of treating AIDS, Biktarvy in very rare cases, also caused fatal autoimmune disorders.

The future of the drug:

Biktarvy, in its trial phases has shown to be highly efficient with minimum challenges and threats. It has also helped raise Gilead back in the field of bio-pharmaceuticals. The FDA approval has paved way for the long term sustainability of the company. It will continue to compete in the field of its core franchise.

Can Anorexia Be Caused By Cancer?

New cells are formed in the early stages of life to facilitate the growth of the body. Even when a person ceases to grow, the body is in dire need of new cells to replace the worn-out ones. All new cells formed result from the division of a pre-existing one. However, normal cells in the human body are programmed to multiply only a certain number of times and eventually face death. Cancer causes these cells to multiply uncontrollably. This unchecked cell-growth leads to the accumulation of a mass of cells called a tumor. 

The field of immunology has seen great advances. But, cancer research has been particularly challenging very since the inception of oncology as a science. Adding to the complexities, a number of cancer patients in the contemporary population show a weight-related response to the disease. From the aforementioned perception of cancer, it seems more likely that the disease would cause a gain of mass. So, cancer and anorexia should be opposite ends of the nutrition spectrum. But people with advanced stages of the disease are actually known to show symptoms of anorexia like fatigue and a lost appetite.

How is this caused?

This condition is referred to as the Cancer Anorexia Cachexia Syndrome (CACS). Cachexia is a medical term used to describe a collection of symptoms like muscle atrophy, loss of weight and weakness. CACS is a wasting disorder of the body resulting from malignancies of the gastrointestinal tract, pancreas, the thoracic region or the head and neck. It comes with poor prognosis which means that there are very less chances of the patient’s survival. There are almost no established treatments for this condition.

This syndrome can be caused due to a number of reasons

Changes caused by the tumor

Difficulties in swallowing caused by tumor formation can directly impinge gastrointestinal functions. A significant decline in food intake is also caused by tumor-derived substances like lactate. These disturb the normal metabolic cycles and are potent anorexic agents. Tumors alter nutrient distribution plans of the body and deprive other tissues of essential micronutrients like Zinc. Inflammation caused by these cancerous cells also induces the release of cytokines.

These effects lead to irregular secretions of hormones that help the body regulate appetite thus resulting in food restriction.

Central causes

The modulation of various nutrients in turn affects the transmission cascades of the central nervous system. This might lead to conditions like depression and chronic pain thus altering eating habits.

Effects of treatments like Chemotherapy can also contribute to causing CACS.

Symptoms and diagnosis of CACS

Not everybody who has this syndrome looks malnourished. This is because the person could have been overweight before CACS became a chronic illness for him. Hence, there are a few clinical assessments to determine if a person is actually a victim of this disorder.

·        The person has lost over 5% of his body weight unintentionally

·        BMI < 20 in a person less than 65 years old
BMI < 20 in a person 65 years or older

·        Body fat is less than 10%

·        An increased level of cytokines in the blood (resulting from inflammation)

·        Serum albumin level < 35 g/L

People with this syndrome might not respond equally well to treatments of cancer.  A high percentage of people with these advanced cancers are known to show bone metastasis i.e. relocation of cancerous cells to the bone. Their immunity can be lowered further and they hence experience a highly diminished quality of life.

Management of the disorder

The cancer supportive care landscape has been widening with robust drug development as summarized in the GBI Research report, “Cancer Supportive Care Drug Development Pipeline Review,2017”. There are a number of ways in which CACS can be managed:

·         Appetite stimulants

The positives of dietary counseling from trained experts haven’t been demonstrated. Appetite stimulants like corticosteroids or progestational agents have a greater impact. They have shown to increase the patient’s appetite in a few cases but do not have a long lasting effect. 

·         Enteral and parenteral nutrition

Administration of food directly through the gastrointestinal tract of through intravenous injections can be employed. However, this has been extensively studied and has only shown to have the required effect in rare cases. 

·         Muscle building

If the person still has the ability to exercise, he can take up to resistance training to build muscles.

All these efforts are rarely enough to reverse the effects of CACS. Since this syndrome is a secondary disorder resulting from cancer, treatment of that should be in focus. CACS has no established treatment regimens. It causes great emotional stress not only on the patients but also the family members and close acquaintances. Patients are usually forced to consume more calories in the hope that this will help them live longer. This isn’t always of much clinical benefit. Only compassion and care can help their struggle for survival in the final stages of their life.