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CANCER CAUSES AND TREATMENTSHTML Full Text
CANCER CAUSES AND TREATMENTS
Anupam Saini 1, Manish Kumar 1, Shailendra Bhatt 1, Vipin Saini 2 and Anuj Malik * 1
Department of Pharmaceutics 1, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala - 133207, Haryana, India.
M. M. University 2, Solan - 173212, Himachal Pradesh, India.
ABSTRACT: Cancer is a genetic disorder that results from genetic or epigenetic alterations in the somatic cells and has abnormal cell growth which may be spread to other body parts. In 2018, 18 million cancer was recorded globally in which 9.5 million cancer cases in men, 8.5 million cases in women, and 9.6 deaths were also recorded in the same year. The most spreading cancer globally is prostate, breast, lung stomach, colorectal cancer, non-melanoma skin malignancies but there are 100 types of cancers that affect humans. The impact of cancer is increasing significantly day by day. Tobacco is 22% responsible for causing cancer, 15% cancer is caused due some infections like HIV, hepatitis b, Epstein-Barretc, and 10% is due to poor diet, obesity, excessive consumption of alcohol, exposure to ionizing radiation, etc. In this review article, we try to shed a light on various cancer-causing factors, type of cancer, how the cancer starts, sign or symptom of cancer, diagnosing tests, the treatments of cancer and problems related to cancer treatments. Nowadays, a lot of research is going on precision medicine for a better future of cancer treatments. The common therapies are given to patient’s chemotherapy, radiation therapy, immunotherapy, surgery and hormone therapy and combinations of these therapies. Stem cell transplant is also the best therapy for cancer but it given after the common therapies to recover the patient from blood loss and help in making the patient healthy.
Epigenetic, Epstein-Barr, Chemotherapy
INTRODUCTION: Cancer: Cancer is a disorder that results from genetic or epigenetic alterations in the somatic cells and has abnormal cell growth which may be spread to other body parts. They form a subset of neoplasm. The unregulated growth of cells in a group called neoplasm or tumor and they form a lump or mass and may be distributed diffusely 1-3.
It was predicted by Global demographic characteristics that about 420 million new cases of cancer by 2025 annually, which means increasing cancer incidence in years. Cases of cancer about 18 million in 2018 were recorded worldwide; in men, about 9.5 million and women about 8.5 million.
Globally about 9.6 million deaths were estimated in cancer 4, 5. The commonest cancers are prostate cancer (1.28 million), female breast cancer (2.09 million), colorectal cancer (1.1 million), stomach cancer (1.03 million) and non-melanoma skin malignancies (1.04 million) 6, 7. Cancer-related deaths, from most to least frequent, are due to lung cancer (1.76 million), colorectal cancer (862,000), and stomach cancer (783,000), liver cancer (782,000). Over 100 types of cancers affect humans 8.
- Globally about 9.6 million in 2018 deaths were estimated in cancer which represents the cancer is the second leading cause of deaths and about 1 in 6 deaths are due to cancer 4.
- About 70% of deaths in middle- income and Low Countries are due to cancer 5.
- The main and the most important cause of cancer is tobacco use, approximately 22% 10, 11.
- There are also some infections that cause cancer, like Human papilloma Virus (HPV), are causes 25% of cancer in middle and low-income countries 11.
- In 2017, solely twenty-sixths of low-income countries reported having pathology services usually obtainable within the public sector.
- More than ninetieth of high-income countries reported treatment services square measure obtainable compared to but a half-hour of low-income countries 12.
- The impact of cancer is increasing significantly day by day.
- The cancer policy is necessary for all countries, but many countries do not have these policies.
Problems: Globally, about 9.6 million in 2018 deaths were estimated in cancer, which represents the cancer is the second leading cause of deaths. The most common cancers are: 4, 8
- Lung (2.09 million cases)
- Breast (2.09 million cases)
- Colorectal (1.80 million cases)
- Prostate (1.28 million cases)
- Skin cancer (non-melanoma) (1.04 million cases)
- Stomach (1.03 million cases)
The most common causes of cancer death are cancers of:
- Lung (1.76 million deaths)
- Colorectal (862 000 deaths)
- Stomach (783 000 deaths)
- Liver (782 000 deaths)
- Breast (627 000 deaths)
Causes of Cancer: 13, 14
- There are many causes which may cause cancer in different body parts like mainly 22% deaths are due to tobacco consumption, 10% of deaths are due to poor diet, obesity, lack of physical activity, excessive drinking of alcohol or other facts include certain exposure to ionizing radiation, environmental pollutants, and infection.
- About 15% of cancer in the world is due to some infections like hepatitis b, hepatitis c, human papillomavirus infection, helicobacter pylori, and immunodeficiency virus (HIV), Epstein - Barr virus. These factors are at least partly responsible for changing the genes.
- Inherited genetic defects from patient’s parents are also responsible for 5-10% of cancer.
- Cancer is caused by the interaction between genetic factors and 3 categories of agents which we consume externally including:
- Physical Carcinogens: Ionizing radiation such as radon, ultraviolet rays from sunlight, uranium, radiation from alpha, gamma, beta, and X-ray-emitting sources.
- Chemical Carcinogens: Compounds like n-nitrosamines, asbestos, cadmium, benzene, vinyl chloride, nickel, and benzidine and contains about 60 known potent cancer-causing toxins or chemicals in cigarette smoking or tobacco consumption, a drinking water contaminant (arsenic), a food contaminant (aflatoxin) 12.
- Biological Carcinogens: Infections from certain bacteria, viruses, or parasites and Pathogens like human papillomavirus (HPV), EBV or Epstein-Barr virus, hepatitis B and C, Kaposi’s sarcoma-associated herpesvirus (KSHV), Markel cell polyomavirus, Schistosoma spp., and Helicobacter pylori.
Aging is also the cause of cancer. Age is the common incidence of cancer, which dramatically rises.
- Genetics:Genetic is the commonest cause for cancer or tumor-like Ovarian, breast, prostate, skin cancer, colorectal cancer. Individuals that eat heaps of cooked meat can also increase risk because of compounds fashioned at high temperatures. Proving that a substance doesn't cause or isn't associated with hyperbolic cancer risk is tough.
Types of Cancer: Cancers are divided into various types that are: 15
- Carcinomas: It starts in the tissue or the skin, which covers the glands and internal organ surface. It forms a solid tumor. Breast cancer, prostate cancer, colorectal cancer, lung cancer.
- Sarcomas: It starts in the tissues which connect and support the body. It can be formed in nerves, tendons, joints, fat, blood vessels, bone, lymph vessels, muscles, or cartilage.
- Leukemia’s: Leukemia is a cancer of the blood. It begins when healthy blood cells grow uncontrollably and change. It is divided into 4 types, that are acute myeloid leukemia, acute lymphocytic leukemia, chronic myeloid leukemia, and chronic lymphocytic leukemia
- Lymphomas: Lymphoma is cancer that begins in the lymphatic system and it is a network of glands and vessels that helps to fight with infection. Hodgkin lymphoma and Non-Hodgkin lymphoma.
- Central Nervous System Cancers: Cancer that starts in brain tissues and spinal cord called “brain and spinal cord tumors”, and others primary CNS lymphomas, vestibular schwannomas, gliomas, pituitary adenomas, primitive neuro-ectodermal tumors, meningiomas, and vestibular schwannomas.
- Multiple Myeloma: Multiple myelomas is cancer that begins in plasma cells, another type of immune cell. The myeloma cells which are plasma cells, are build up in bone marrow and make tumors in bones. It is called plasma cell myeloma and Kahler disease.
- Melanoma: It starts in cells that become melanocytes. These cells are specialized cells that make melanin, i.e., the pigment that gives the color to the skin. Mainly melanomas develop on the skin, but it can also develop in other pigmented tissue like an eye.
- Other Types of Tumors:
Germ Cell Tumors: It is the type of tumor that starts in the cells which give rise to eggs or sperms. This can be occurring anywhere in the body and either malignant or benign.
Neuroendocrine Tumors: Neuroendocrine tumors form from cells that release hormones into the blood in response to a signal from the nervous system. It forms from those cells which release hormones in blood in response to signal from the nervous system. These tumors, which can create higher-than-normal amounts of hormones, will cause many various symptoms. It may be either benign or malignant.
How it Begins: There are several steps by which cancer begins in the body: 16
- Cell Changes and Cancer: Our body is made up of small units called cells and more than 100,000,000,000,000 cells combine to makes our body. All types of cancer firstly start in cells by changes. Usually, our body has the right number of cells because the cell produces signals. if any signal is missing than cells may start to multiply unnecessarily and make a lump which also called a tumor. But there are also other types of cancer which start from different pathways like blood cells this cancer is called leukemia, and they not make a solid lump.
- Genes and Cell Division: Our body has different cells for a different job, but they all are similar. They all have nuclei that control the cell and the nucleus contains chromosomes which are made up of thousands of genes. A long string of DNA (Deoxyribonucleic acid) called genes, which contain a coded message which tells the cell how to behave or divide. When the right time occurs for cell division, the cells divide and make the exact similar copies of them. One cell divides into 2 identical cells, and then 2 cells divide into 4, and so on.
FIG. 1: CELL DIVISION
- Gene Changes within Cells (Mutations): When a cell is dividing mainly, a mutation occurs in this step but also by the chemical changes which are coming from outside like tobacco smoke, and it is happening by chance. Mutation means the gene is copied twice, damaged or lost. The meaning of mutation is that the cells are not growing by its instructions, and grow unnecessarily. Mutation of genes may mean that a cell stops producing proteins that require cell division and may produce too many proteins by which the cell division occurs rapidly and form lump or tumor, the tumor is made up of millions of cancer cells.
- How Cancer Grows: A cancer can continue to grow because cancer cells act differently than normal cells. Cancer cells have the same needs as normal cells. Cancer cells need nutrients and oxygen from blood vessels to survive and grow. The tumor can easily grow by nutrients and oxygen. They need a blood supply to bring oxygen and nutrients to grow and survive. When a tumor is very small, it can easily grow, and it gets oxygen and nutrients from nearby blood vessels. Cancer cells are different from normal cells because of they:
- Divide out of control
- They are immature and don’t develop into mature cells with specific jobs.
- Avoid the immune system.
- Ignore signals that tell them to stop dividing or to die when they should.
- Don’t stick together very well, and through blood or lymphatic system, they can spread to other body parts.
- Grow into and damage tissues and organs.
FIG. 2: HOW CANCER GROWS
How it Spread: As the tumor grows, the cancer cells are carried with the lymphatic system or bloodstream to other body parts, Then the cancer cells may be developed into new tumors and it is called metastasis. Cancer may spread to lymph nodes, which are bean-shaped organs and tiny that helps to fight with infection. Neck; underarms and groin area etc. these are the body parts where the lymph nodes are located. Cancer may also spread through the bloodstream to other body parts like the liver, bones, brain, or lungs. If cancer spreads to different body parts from that area where it began than it is named as metastatic cancer of that particular area where it starts.
For example, if lung cancer spreads to the breast than it is called metastatic lung cancer, not breast cancer.
Common Cancers: There are more than 100 cancers which affect humans but commonest among all are: Bladder, breast (female-malele), endometrial, thyroid, colorectal cancer, leukemia, lung (including bronchus), melanoma, kidney (renal cell and renal pelvis) cancer, non-Hodgkin lymphoma, prostate, pancreatic cancer 17-19.
Symptoms and Signs of Cancer: 20
Early Symptoms: At the earliest stage cancer gives no sign or symptoms by which we cannot indicate the disease. Moreover, the symptoms or signs are shown in harm condition.
Some common symptoms that may occur with cancer are as follows:
- Persistent Cough or Blood-Tinged Saliva: If anyone is having cough from a month or blood in the mucus, then these are the sign of bronchitis or sinusitis, but they could be symptoms of neck, head or lung cancer.
- A Change in Bowel Habits: It usually depends on the diet of a person and fluid intake. People with cancer felt that they need to have a bowel movement and also feel the same if they had if this symptom lasts more than a few days than it is a symptom of cancer. Mainly in cancer, there is continuous diarrhea.
- Blood in the Stool: It is also the early symptom of cancer by which we can examine cancer. The evaluation includes colonoscopy etc.
- Unexplained Anemia: People with low RBC in their blood from normal, then this condition is called anemia. Bowel cancer can cause iron-deficiency anemia. The evaluation includes X-ray studies or endoscopy of your lower and upper intestinal tracts.
- Breast Lump or Breast Discharge: Most breast lumps are noncancerous tumors like cysts or adenomas, but all lumps are needed to check. The evaluation includes Ultrasound and x-ray study included MRI of the breast. Discharge from the breast is also the sign of cancer, and it is quite common, but not from only one nipple or bloody.
- Lumps in the Testicles: Men with cancer have an uncomfortable or painless lump on a testicle.
- Change in Urination: The symptoms are slow urine flow, frequent urination, change in bladder function or small amounts of urine, caused by a urinary infection in women or by an enlarged prostate gland. Most men will suffer from enlargement of the prostate gland as they age, these may be the symptom of prostate cancer. The evaluation includes PSA blood tests and the biopsy of the prostate.
- Persistent back pain
- Unexplained weight loss
- Stomach pain and nausea
- Bone pain
Late Symptoms: These symptoms are depending on cancer type, location or where the cancer cells have spread.
- Change in bowel or bladder habits
- Obvious change in the size, color, shape, or thickness of a wart or mole
- Indigestion or difficulty in swallowing
- Change in size, shape, color or thickness of mole.
- A sore throat that does not heal.
- Thickening or lump in the breast, testicles, or elsewhere
Other signs or symptoms may also alert you. These include the following:
- Unexplained loss of weight or loss of appetite
- Unexplained low-grade fevers may be either persistent or not.
- Recurring Infections
- Pain in the bones and other body parts
Many cancers will present in with general signs or symptoms, but they often have more than these symptoms, for more specifications. For example, lung cancers have a common symptom of pain in the chest. The patient may have a persistent cough with bleeding. Lung cancer patients are become very fatigued due to shortness of breath.
Diagnosis: Diagnosis of cancer is carried by doctors by taking screening tests of patients. For example, colonoscopy, mammography, and a pap test. Other tests are also performed before screening tests to check the abnormalities in the body. For example, CT scan, MRI scan, X-rays and ultrasound. In that area which is not clearly visualized like some lymph nodes or inside bones, radionuclide test is performed for this purpose.
Person with cancer who have no symptom then they diagnosed during tests of other condition or issues, and if any person has symptoms of cancer doctor will perform various tests 21, 22.
Lab Tests: Lab test include urine, blood and other body fluids to measures the substances which are responsible for the cancer in our body, like low and high levels of the substance which can cause cancer. Tumor markers are produced by the cancer cells and other cells in response to cancer. Lab tests are not the accurate result for cancer diagnosis, so doctor needs to clarify these tests by performing other cancer tests also.
Imaging Tests: In this test, the picture of the area inside the body are created which help to see the tumor present or not. It involves tests like:
Ct Scan: This scan is used to create 3-dimension images of your organs from different angles by X-ray machines which are linked to the computer. Usually, before the scanning, you may have to take a dye or other contrast material which helps to make the picture easier to identify certain areas of body. In the donut-shaped scanner machine the picture taken by moving around the body.
MRI: This scan is also used to take the picture of the body organs by taking pictures in slices and create detailed image. Radio waves and powerful magnet are used to take the slices. This scan shows the exact difference between unhealthy and healthy tissues. As in CT scan, before MRI scans also you have to take a dye for further scan. It is a round chamber machine in which the body is pushed and it makes rhythmic beats and loud thumping noise.
Nuclear Scan: It is also called a radionuclide scan because radioactive material is used to take the picture of body organs. As a CT and MRI scan, the person needs to receive a small amount of radioactive material in the injection form known as a tracer. It collects in the bones by flowing through blood. In this scanner measure the radioactivity and create pictures of organs or bones on film or on the screen of the computer. It includes 2 scans named as: Pet and bone scan.
Bone Scan: It is used to checking for damage to bones or abnormal areas. Before the scan person has to take the small radioactive material in his/her vein, it travels through the blood and collects in an abnormal area in the bones. A special scanner pictured the material where it collects, and these areas are called hot spots.
Pet Scan: In this scan, the radioactive glucose material is used for the 3-D picture of body organs because cancer cells consume more glucose than healthy cells.
Ultrasound: In ultrasound, high energy sound waves are used for the echo of tissues because these waves, people cannot hear. The computer uses these echoes to create a picture of body organs where a device called transducer slowly moves on the skin and the picture is called a sonogram.
X-rays: In X-ray scan, x-rays are used in low doses of radiation to create a picture of body organs and you have to stay still withholding the breath for 1-2 seconds when the beam is directing on the body part.
Biopsy: Biopsy is the test in which the doctor removes a sample of tissue from the patient's body for diagnosing cancer. Then a pathologist does further test and looks tissue in the microscope and described all details in the pathology report. Sedative and anesthesia are given to patients before biopsy for relaxation. The biopsy sample is obtained in various ways:
- With Needle: Needle is used to withdraw fluid or tissue from the body. This method is used for spinal taps, bone marrow aspirations, prostate, and liver and breast biopsies.
- With Endoscopy: In this method, the endoscope which is a thin and lighted tube, goes inside from natural body openings, such as anus or mouth to examine the areas inside the body. If the doctor sees any abnormal tissue during an examination, then he removes the abnormal tissue with normal tissues. For example, Colonoscopy, bronchoscopy.
- With Surgery: Through surgery, the area of abnormal cells is removed. It may be excisional, in which the surgeon removes the entire area of abnormal cells with some normal cells and incisional, in which a small part of an abnormal area is removed.
Diagnosis: After tests and reports if anyone having cancer then the doctor will figure out the stage of cancer for the best treatment.
Side Effects of Cancer Treatments: The treatment of cancer can affect also to the normal cells, tissue, and organs 23. Side effects are the effects of treatment which are shown with therapeutic effect. Common side effects are shown below 24-26
- Appetite loss
- Bruising and bleeding (thrombocytopenia)
- Fertility issue in boys and men
- Fertility issue in girl and women
- Flu-like symptoms
- Hair loss (Alopecia)
- Infection and Neutropenia
- Memory or concentration problems
- Mouth and throat problems
- Nausea and vomiting
- Nerve problems (Peripheral Neuropathy)
- Organ related inflammation and immunotherapy
- Sexual health issue in both men and women
- Skin and nail changes
- Sleep problems
- Urinary and bladder problems.
Types of Cancer Treatments: There are various types of cancer treatments, which depend upon the cancer type and how to advance it is. Some patients have only one cancer treatment but mainly have a combination of treatments like surgery with radiation therapy.
The various types of treatments are: 27
- Surgery: To prevent or reduce the disease’s spread and remove cancer from the body, surgeon may remove lymph nodes.
- Radiation Therapy: In this therapy high doses of radiation are used to treat cancer by shrinking tumors and to kill cancer cells.
- Chemotherapy: In this therapy, chemicals are used to treat cancer by killing cancer cells and also by shrink tumors but have severe side effects.
- Immunotherapy: In this therapy, the immune system is boost by medication or other treatments. Example, adoptive cell and checkpoint inhibitors treatment.
- Targeted Therapy: In this therapy, changes in a cancer cell that help them divide, spread and grow by targeting and immune system also boost. Example, monoclonal antibodies and small-molecule drugs.
- Hormone Therapy: In this therapy, hormones are used to treat cancer, such as prostate and breast by stop and slow growth.
- Stem Cell Transplants: In this therapy, the stem cells restore in cancer patients, which are destroyed by very high doses of radiation or chemotherapy.
- Precision Medicine: It is the newer approach, in which the best treatment for a patient is determined by genetic testing.
Surgery: To prevent or reduce the disease’s spread and remove cancer from the body, the surgeon may remove lymph nodes. Small thin knives called scalpels are used by the surgeons and other sharp tools also used to cut through muscle, skin and sometimes bones during surgery. These cuts are painful after surgery before surgery anesthesia is given to the patient to relieve from pain 29.
Surgeries are used for the solid tumor, which is the local treatment because it contained in one area. Surgery is not used for metastatic cancer or leukemia i.e., blood cancer. The patient needs good nutrition before and after the surgery if he/she is underweight and weak.
Food intake of the patient will change after the surgery of the intestine, mouth, throat or stomach. The food is given in an IV or feeding tube. Other surgeries also present for treatment of cancer which does not involve any cuts are:
Cryosurgery / Cryotherapy: This therapy is used to treat precancerous growth on the cervix and skin by argon gas and nitrogen gas to destroy abnormal cells from extreme cold.
Lasers: This treatment is used for more precise surgeries because it has an accurate focus on small areas and it is also used to shrink or destroy a tumor. This powerful beam of light is used for treatment on the skin or inside the lining of internal organs. For example, vaginal, cervical, basal cell carcinoma.
- Hyperthermia: In this therapy, the small body part is exposed to a high temperature so this heat kills cancer cells and makes sense to radiation or chemotherapy drugs. High energy radio waves are used to provide heat.
- Photodynamic Therapy: In this therapy, photodynamic drugs are used to treat cancer cells. These drugs are reacting with a particular light, and then tumors are exposed to that particular light, and this drug becomes active and kills cancer cells that are nearby it. Non-small cell lung cancer and skin cancer are treating by this therapy.
How it Works: Surgery conditions are depending on the cancer type and advancements of cancer. Surgery can be used to:
- Remove the entire tumor
- Remove some but not all tumor. De-bulking is used when removing an entire tumor might damage an organ or the body.
- Remove tumor that causing pressure or pain.
Problems: Common problems are:
- Pain: Pain at the part of the body where surgery has happened is a common problem regarding surgery.
- Infection: Infection can cause after surgery, it can be prevented by taking antibiotics.
Radiation therapy/Radiotherapy: In this therapy high doses of radiation are used to treat cancer by shrinking tumors, killing cancer cells, and slow the growth of cancer cells by damaging their DNA because the damaged DNA does not repair and the cell die which is removed by the body. The treatment takes weeks or months and prevents from returning. Radiopharmaceuticals are the drugs of systemic radiation therapy, are used to treat pain that spread to bones, and the external beam is used to treat pain, loss of bowel, bladder control, and trouble breathing by the shrinking tumor. Systemic means the treatment travel through the blood to tissue throughout the body and treatment received by IV and by swallowing 30-33.
- Brachytherapy is used to treat breast, neck, cervix, and eye and head cancer with the help of external beam
- Thyroid cancer is treated by radioactive iodine or i-131.
- Radio nucleotide therapy is used to treat the gastro-entero-pancreatic neuroendocrine tumor and advance prostate cancer.
Radiation therapy is given with other cancer treatments for better results such as chemotherapy, surgery, and immunotherapy. For example, radiation therapy in combination with surgery:
- Before surgery, radiation therapy used to shrink the cancer
- During surgery, the radiation will go directly to cancer,
- After surgery, to kill cancer cells which remain?
Side Effects: Radiation therapy can cause many side effects, which are generally shown by the normal cells that are damaged by the radiation.
Chemotherapy: In this therapy, chemicals are used to treat cancer by stopping or slowing the growth of cancer cells or by killing cancer cells or also by shrink tumors that causing pain and other problems but have severe side effects. Chemotherapy is given only and also given with other cancer treatments that depend upon the cancer type 34-36.
- Neo-adjuvant chemotherapy, in this tumor, is made smaller before surgery or radiation therapy.
- Adjuvant chemotherapy, in this the cancer cells are destroyed, which remains after the treatment.
- Help other treatments to work better.
- It also kills those cancer cells which are spread to other body parts.
Chemotherapy may give in various ways:
- Oral: pills, liquids, and capsules.
- Intravenous (i.v): Directly to the vein.
- Intramuscular (i.m): Given in muscle of thigh, arm or hip.
- Intrathecal: Injected space between the layers of tissues that cover the spinal cord and brain.
- Intraperitoneal (i.p): Directly into peritoneal cavity, that area in the body which contains organs such as, stomach intestine and liver.
- Intra-Arterial (i.a): Directly into an artery.
- Topical: Creams that apply on the surface of the skin.
Mainly chemo is given as IV; a thin needle is placed in vein but it is given through ports or catheters and some time with pump.
- Port: During minor surgery, a small, round disc which is called port, is placed under the skin before treatment and remains until treatment ends.
A catheter connects the port to a large vein and nurses insert a needle into the port to give chemotherapy or draw blood.
- Catheter: It is a thin, soft tube, which has one end places in a large vein in the chest area, and another end is to stay outside of the body. It is also used to give drugs and draw blood.
- Pump: It controls the speed and quantity of drugs that are given from catheter or port. The pumps are of two types internal or external, internal pumps are placed under the skin during surgery, and external pumps are placed outside from the body.
Various tests and scans are used for checking the progress of chemotherapy, include blood tests, CT, Pet, and MRI scans.
Side Effects: Chemotherapy kills the cancer cells but it kills the healthy cells also. Side effects are caused by damaging healthy cells. The side effects are:
- Hair loss
- Mouth sores
- Fatigue, so child care is needed to a patient at least on the day of chemotherapy.
TABLE 1: SIDE EFFECTS
|Part of the body being treated||Possible
|Brain||Fatigue, Hair loss, Nausea and vomiting, Skin changes, Headache, Blurry vision|
|Breast||Fatigue, Hair loss, Skin changes
Swelling (edema), Tenderness
|Chest||Fatigue, Hair loss, Skin changes
Throat changes, such as trouble swallowing, Cough, Shortness of breath
|Head and neck||Fatigue, Hair loss, Mouth changes, Skin changes, Taste changes, Throat changes, such as trouble swallowing, Less active thyroid gland|
|Pelvis||Diarrhea, Fatigue, Hair loss, Nausea and vomiting, Sexual problems (men), Fertility problems (men), Sexual problems (women), Fertility problems (women), Skin changes, Urinary and bladder changes|
|Rectum||Diarrhea, Fatigue, Hair loss, Sexual problems (men), Fertility problems (men), Sexual problems (women), Fertility problems (women), Skin changes, Urinary and bladder changes|
|Stomach and abdomen||Diarrhea, Fatigue, Hair loss, Nausea and vomiting, Skin changes, Urinary and bladder changes|
Immunotherapy: In this therapy, the immune system is boost by medication or other treatments. Example, adoptive cell and checkpoint inhibitors treatment, etc. The immune system is made up of WBC and tissues of lymph nodes help to provide the strength to the body to fight against the disease and infection. It is also called biological therapy, which means the substances used in the treatment made from living organisms to treat cancer. It is not yet widely used, but many immunotherapies are studied in clinical trials.
Some immunotherapies boost the body's immune system to work better or others make easier for the immune system to identify the cancer cells and then destroy it by marking on these cells.
Immunotherapies are given in different ways, include: 37-41
- Oral: Pills or capsules.
- Intravenous (i.v): Directly into a vein.
- Intravesical: Directly into the bladder.
- Topical: Cream applies externally to the surface of the skin at an early stage of skin cancer.
Types of Immunotherapy:
- Checkpoint Inhibitors: These are the drugs that are used to boost the immune system to treat cancer. These drugs do not target directly on tumor cells because these drugs interrupt the ability of cancer cells to avoid immune system attack. They release the brakes which keep t cells, which is a type of WBC and immune system 42.
- Adoptive Cell Transfer: In this, the natural ability of T cell is boosted to fight against cancer and they are taken from the tumor. Then t cells are grown in large batches in the lab and take 2-8 weeks to grow, then given back to the body by a needle in a vein.
- Monoclonal Antibodies: These are proteins which are made up in the laboratory and have the ability to attach with specific targets on cancer cells. It is also called as therapeutic antibodies. Antibodies mark the cancer cells so that the immune system can easily find it and destroy it.
Side Effects: The most common side effects are at needle site like skin reactions. These side effects include:
- Nausea and vomiting
- Muscle or joint aches
- Trouble breathing
- Low and high blood pressure
- Risk of infection
- Organ inflammation
- Heart palpitations
- Sinus congestion
These therapies also cause allergic reactions which will be severe or fatal, but these reactions are rare.
Targeted Therapy: In this therapy, changes in a cancer cell that help them divide, spread and grow by targeting and immune system also boost. For example, monoclonal antibodies, and small-molecule drugs. This therapy is a foundation of precision medicine. In target therapy, specific proteins that help the tumor to grow and spread get interfere to treat cancer. This therapy can treat cancer in different ways, include: 42-45
- It helps the immune system to destroy cancer cells by marking the cells by which the immune system can easily identify and destroy the cancer cells.
- It stops the growth of cancer cells, interfering with proteins that carry the signal on its surface and preventing them from telling the cells to divide. Cancer cells do changes in the proteins that carry the signals to divide, whether the signal is present or not, the cancer cells divide.
- It stops the signals which help to form blood vessels, by interfering with the signals to prevent blood supply, or if the tumor has a blood supply, then this therapy is used to shrink the tumor by the death of those blood supply.
For the growth of a tumor, it requires new blood vessels and form in response to the tumor. The therapy is called angiogenesis inhibitors.
- It delivers the cell-killing substance to cancer cells, by attaching the substance on the cell surface and cell take up these substances and can cause them to die. Like monoclonal antibodies, which are combined with chemotherapy drugs, toxins, and radiation.
- It can cause the death of cancer cells by the natural process of cell death.
- It can prevent the production of some hormones which are responsible for the growth of prostate and breast cancer. Hormone therapy is a type of target therapy.
Types of Target Therapy:
- Monoclonal Antibody: These antibodies are get attached to specific targets found on cancer cells and mark cancer cells and help the immune system to find and destroy it. Some antibodies also stop the growth of cancer cells and made self-destructed. These antibodies are proteins that are made in a laboratory.
- Small Molecule Drugs: By their small size these drugs can easily enter inside the cell and used for targets.
Side Effects: The common side effects are diarrhea, liver problems. Other side effects are:
- Mouth sores
- Loss of hair color
- Nail changes
- High blood pressure
- Skin problems include dry skin and rash.
- Problem with wound healing and blood clotting
Rare side effects are: Might a whole form through the wall of the small intestine, esophagus, large bowel, or stomach
These side effects may prevent or treated by medicines.
Note: This therapy has some drawbacks, they are:
- Cancer cells become resistant to them so target therapy can use with other cancer therapies.
- Drugs are hard to develop for some specific targets like target structure and function.
Hormone / Hormonal / Endocrine therapy: In this therapy, hormones are used to treat cancer, such as prostate and breast by stop and slow growth of those hormones 46-49.
If this therapy is taken for prostate cancer then regular PSA tests performed for checking the progress of the therapy. If the PSA level will stay the same or go down then the therapy is working, but if the PSA level goes up then are results that the therapy is not working.
If this therapy is taken for breast cancer then regular checkup of neck, chest, underarm and breast areas is performed. When this therapy is used with other cancer treatments:
- Neo-adjuvant therapy, in this tumor is made smaller before surgery or radiation therapy.
- Adjuvant therapy decrease the risk of coming back of cancer after therapy.
- Destroy cancer cells which are come back after treatment.
This therapy is given in many ways including:
- Oral: Pills to swallow
- Surgery: Remove organs which produce hormones, like ovaries in women and testicle in men are removed.
- Injection: Injection given in muscle in the arm, hip, or thigh.
Side Effects: The side effects are different in different persons. This therapy blocks the ability to produce hormones or interrupts with hormones leads to unwanted side effects. The side effects are different in different persons.
- Weakened bones
- Loss of interest in or ability to have sex
- Hot flashes
- Tender and enlarged breast.
- Vaginal dryness
- Mood changes
- Loss of interest in sex
- Hot flashes
- Change in periods if not yet reached menopause
Stem Cell Transplant: In this therapy, the blood-forming stem cells restore in a cancer patient, which is destroyed by very high doses of radiation or chemotherapy. The stem cells are grown in a different type of blood cells which are necessary to be healthy, the main type of blood cells are: 50-52
- RBC (Red Blood Cells): Carry oxygen throughout the body.
- WBC (White Blood Cells): Part of the immune system and help the body to fight against infection.
- Platelets: Help in blood clotting.
This therapy usually does not work against cancer directly except for some type of leukemia and multiple myeloma, but it helps the patient to reproduce the stem cells after treatment with high doses of chemotherapy and radiation or both therapies. After the allogeneic transplant, the graft-versus-tumor effect happens, which means WBC from donor (graft) attack on the tumor that remains after the high dose treatments, and this effect improves the success of treatment 53, 54. This therapy is very complicated and expensive.
The process starts with high doses of chemotherapy, radiation or both, and it goes on for a week or two after this treatment a few days are required to rest, it takes few months to complete. Then the stem cells are given through an IV catheter, this is like receiving a blood transfusion and it takes 1-5 h.
The recovery phase is started after receiving stem cells, in this phase the received stem cells start making new blood cells.
Even after the blood counts recover all blood cells, it takes several months for autologous and 1-2 years for allogeneic or syngeneic transplants.
Types of Stem Cell Transplant: Stem cells are injected through a needle in the vein, once they enter the bloodstream, and then they get a place of cells that get destroyed by treatments by traveling to bone marrow. The stem cells come from bloodstream, bone marrow, and umbilical cord 55-57.
A transplant can be:
- Allogeneic: In this, the stem cells come from someone else like blood relations or other people.
- Autologous: In this, the stem cells come from the patient itself.
- Syngeneic: The stem cells come from identical twins if the patient has one.
Side Effects: Bleeding and increased risk of infection are the problems caused by cancer treatments before a stem cell transplant. If a patient has an allogeneic transplant, that might develop graft-versus-host disease, this means the WBC from a donor (graft) recognized cell in the body (host) as foreign and attacked them by this the skin, liver, intestine, and other organs are getting damaged. Steroids or other drugs are used to suppress the immune system and help to treat the graft-versus-host disease 58-59.
Precision/Personalized Medicine: It is the newer approach, in which the best treatment for a patient is determined by genetic testing. Nowadays, cancer treatments are is same for patients who have same cancer and the same stage of cancer, but the responses are different in some patients. After a lot of research, scientists understand those tumors have genetic changes that cause cancer cells to grow and spread. The genetic changes in different cancer may be the same. Scientists see the future in precision medicine because it helps in receiving the best treatment for cancer. The research is going on, to test the treating patients with treatments that target the cancer-causing genetic changes in the tumor, many drugs are used as treatment known as target therapies 60.
Precision medicine helps the doctors to decide the best treatment because it has all the information regarding the genetic changes in the tumor, size, type, and if spread. Nowadays, the patients receive a combination of treatment for cancers include chemo, radiation, immunotherapy, and surgery if the doctor has information, then the treatment is going to be easy.
CONCLUSION: In this review paper cancer and treatments of cancer were illustrated in detail like sign or symptoms, diagnosing tests and how the cancer cause, spread, etc. The cancer treatments include surgery, immunotherapy, chemotherapy, target therapy, hormone therapy, radiation therapy, stem cell transplant, precision medicine. These therapies include many drugs, like antibiotics, which are mainly used in chemotherapies, different targeted systems to treat cancer directly like nanotechnology, microspheres, etc. Different radiations are used to treat cancer in radiation therapies that directly attack cancer cells. In hormone therapy, different hormones are used to treat cancer, mainly breast and prostate cancer which are caused by hormones. In immunotherapy, the immune system is making stronger to fight against the cancer cells by different drugs.
Out of these therapies, commonly therapies and a combination of therapies are used to treat cancer such as radiation therapy with surgery, hormone therapy with surgery, chemotherapy with immunotherapy, etc. But these therapies have different problems/side effects because cancer cell which are made from certain genetic changes and genetic changes different in different patients and cancers. After a lot of research about these therapies, scientists prefer precision medicines for the betterment of cancer treatment because in this therapy doctor knows all about the genetic information of cancer cells, then it makes the treatment quite easy and with the help of this information problems/side effects can be decreased.
And after these therapies stem cell transplant is the best therapy to make the patient healthy by autologous, syngeneic transplant because it has lesser side effects, but allogeneic transplants have more side effects than these two because in this stem cells are taken from other person or blood relation.
ACKNOWLEDGEMENT: The authors are grateful to the Department of Pharmaceutics, M. M. College of Pharmacy, M. M. (Deemed to be University), Mullana, Ambala, Haryana, India, for providing various facilities in connection with this review work.
CONFLICTS OF INTEREST: Authors declare that there is no potential conflict of interest.
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How to cite this article:
Saini A, Kumar M, Bhatt S, Saini V and Malik A: Cancer causes and treatments. Int J Pharm Sci & Res 2020; 11(7): 3109-22. doi: 10.13040/IJPSR.0975-8232.11(7).3109-22.
All © 2013 are reserved by the International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
A. Saini, M. Kumar, S. Bhatt, V. Saini and A. Malik *
Department of Pharmaceutics, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India.
21 October 2019
01 January 2020
04 March 2020
01 July 2020


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Beloved, a I do not consider that I have made it my own; b but this one thing I do: forgetting what lies behind and straining forward to what lies ahead,
I press on toward the goal for the prize of the heavenly c call of God in Christ Jesus.
New Revised Standard Version Bible, copyright 1989, Division of Christian Education of the National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved. (New Revised Standard Bible Version Online)

domain: literature


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Kabul, Afghanistan – When 55-year-old Khairullah from a village in Afghanistan’s northern Jawzjan province was invited to join a meeting after Friday prayers on March 27, he was not prepared for what he witnessed.
Despite the unusually cold spring weather, Khairullah, who asked for his name to be changed, and his neighbours were welcomed by Taliban fighters holding their AK-47s and dressed in complete medical PPE (personal protective equipment) for a workshop on the prevention of the coronavirus.
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“It’s been about a week since the Taliban has been conducting such awareness campaigns here. They are asking people to use masks and gloves, talking about washing hands with soap, those kinds of things,” Khairullah told Al Jazeera, in a phone call from his village in the Taliban-controlled Darzaab district.
“They have cancelled all public gatherings, weddings and have asked people to pray at home instead of the mosques,” he added.
While Afghanistan has fewer than 400 confirmed cases of coronavirus, there are worries of an outbreak of the deadly virus in a country already facing years of conflict, displacement and poverty.
“We were directed by our health commission to hold public awareness campaigns, which we have undertaken in areas we control. We are also distributing pamphlets with advice on prevention of coronavirus in these districts,” Qari Khalid Hijran, who described himself as the Taliban’s newly-appointed director of public health of the Baghlan province, told Al Jazeera.
Government welcomes move
As surreal as it was for many Afghans, the Taliban’s initiative was welcomed by the country’s Ministry of Public Health.
“We noticed photos circulating on social media that show the Taliban’s campaign, and regardless of their intention, we appreciate the cooperation from anyone or any group that supports the fight against coronavirus,” Wahidullah Mayar, adviser to the Ministry of Public Health, told Al Jazeera.
Visuals shared by Khairullah and the Taliban of the coronavirus workshops show men dressed in white medical gear and masks, holding disinfectant sprays as well as heavy weapons, as they gather around large posters of instructions on avoiding the coronavirus.
The Taliban flag and insignia were also visible in some of those photos.
The printed material, issued by the Taliban’s “General Commission for Public Health”, listed precautions that people should take, including regular prayers, eating “halal” as well as medical advice.
“We also provided villagers a list of vegetables that contain high amounts of vitamin C to boost immunity,” Hijran said.
While there are concerns over the Taliban’s “health commission” providing information that meets medical standards, Mayar said his ministry was also running simultaneous campaigns in all provinces.
“We provide healthcare services in all provinces through trained health workers and 26 partner NGOs, even in Taliban areas. So there are professional medical workers that Afghans can turn to,” he said.
Safe passage to health workers
The Taliban has also offered safe passage to health workers and international organisations working to prevent the spread of coronavirus in Afghanistan.
“We are willing to allow and support government health workers or NGOs who can help the villagers in our areas. All they have to do is ask for our permission before coming so we can assess them, and we will let them work here,” said Hijran, adding that they were “ready to accept any help for the sake of people”.
Only last year, the Taliban had banned operations by the World Health Organization and the Red Cross in areas it controlled, citing “suspicious activities”. It later partially lifted the Red Cross ban.
Many Afghans also hope that the Taliban takes this opportunity to act on a United Nations call for a ceasefire in all conflict zones, due to the pandemic.
“The Taliban mentioned that if there is a [COVID-19] positive case, it will impose a ceasefire in that region. I ask them on behalf of the ministry to call for a ceasefire in the whole country,” said Mayar. “Let us fight this disease together instead of fighting each other.”
However, despite its public service campaign, the Taliban continues to attack Afghan forces, often claiming civilian lives.
A recent peace deal signed with the United States to end the 18-year war amid hopes for negotiations with the Afghan government have done little to prevent those attacks.
“They coronavirus hasn’t affected the conflict much. There is still fighting in many areas, and unless the fighting stops, the doctors and health teams can’t openly work in these areas,” Khairullah said.
Taliban quarantines virus suspects
Khairullah added that resources in his village were thinly stretched amid the pandemic.
“There is only one health centre in our district with 10 beds and a few health workers. Medicine supplies are low and I heard that the Taliban has also requested government officials to bring more medicines,” he told Al Jazeera.
While the Taliban may not have stopped fighting, the group says it has taken the coronavirus threat seriously by moving its fighters from the battlefields for the COVID-19 campaign.
The group has enforced lockdowns in affected areas and even quarantined those suspected of having the virus, especially Afghan refugees returning from Iran, the worst-hit Middle East country.
“About two weeks ago, they quarantined two villagers who had returned from Iran. They were not allowed to leave their homes and were later tested,” said Khairullah.
In some northern provinces, the Taliban even detained returnees from Iran who had escaped government quarantine facilities.
About two million Afghan refugees live in Iran, with thousands among them being deported to the shared western border in Herat province, making it the epicentre of Afghanistan’s coronavirus outbreak.
Of the nearly 400 cases in Afghanistan, more than 200 are from Herat alone, with seven deaths so far.
Hijran confirmed to Al Jazeera that the Taliban was quarantining and even testing Afghan citizens.
“We have health centres in our areas… in Baghlan, we have two centres. We check returnees in these health centres and even if they test negative, we lock them in homes for 20 days,” he said, adding that the group had conducted 135 tests in Baghlan province so far.
Testing kits available
Hijran also said the Taliban had COVID-19 testing kits, a shortage of which has been a matter of concern for Afghan health workers and organisations.
Fewer tests have made it difficult for the Afghan government to address the magnitude of the pandemic.
“We were provided 950 kits for Baghlan province from the Taliban health commission,” Hijran said, without revealing who provided the kits to the group.
For civilians like Khairullah though, the Taliban’s health initiatives, limited as they might be, provided a much-needed assurance to the people amid the crisis.
“This virus threatens all of us, whether Taliban or civilians or government,” he said.


The aim of this work was to investigate the influence of morphology on its electrochemical properties by comparing ZnO nanostructures in the forms of tetrapods of different sizes, nanorods, and nanoparticles. ZnO tetrapods were prepared by the combustion method and separated into two fractions by size, ruling out the influence of synthesis conditions. Structural and morphological properties of different ZnO nanostructure morphologies were identified by using various characterization techniques: scanning and transmission electron microscopies (SEM and TEM), X-ray powder diffraction (XRD), nitrogen adsorption/desorption measurements at 77 K, and UV-vis spectroscopy (UV-vis). Analysis of electrochemical properties showed the highest active surface area of 0.095 cm2 and the lowest peak separation value of 61.7 mV for large ZnO tetrapods, which are close to the theoretical values. The correlation between the pore size in different ZnO nanostructures because of packing and their electrochemical properties is established. We expect that the detailed analysis of ZnO nanostructures conducted in this study will be advantageous for future electrochemical and biosensing applications of these materials.


text:
Long Sleeve T-shirt
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ABOUT THE ART
This is a shot of a grain silo taken north of Seattle Washington. I made the picture black and white, brought out levels, and then cut away large areas with little pattern in it using a content aware effect so it could look like an industrial complex that just kept going.

domain: artistic


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domain: biology


A solid pitching performance from Bruce Chen leads the Kansas City Royals to a 5-2 win over the Detroit Tigers on Sunday afternoon.
The Kansas City Royals beat the Detroit Tigers on Saturday night 4-3 behind a 6th inning two-run home-run from Salvador Perez.
The Kansas City Royals couldn’t carry the momentum from Thursday’s extra-inning win into their series with the Detroit Tigers as the Tigers …
Mike Moustakas ended a marathon afternoon affair at Kauffman Stadium as his walk-off solo home run gave the Royals a victory over Seattle.
Salvador Perez hit a solo home run and also drove in the winning run for Kansas City in the 8th innings as the Royals beat Seattle on Tuesda…
Alcides Escobar and the Royals prevailed during Monday afternoon’s matchup against the Mariners to begin the homestand.
James Shields goes seven shutout innings to boost the Royals to a 5-0 win on Sunday.
The Toronto Blue Jays score three runs in the bottom of the 8th inning to beat the Kansas City Royals 4-2 on Saturday.
The Toronto Blue Jays hold off a late Kansas City Royals rally as escape with a 3-2 win on Friday night.
The Kansas City Royals have the longest current winning streak in the MLB as they picked up a sweep over the Twins.
Salvador Perez set a Royals record by a catcher as he finished with 11 total bases, including a pair of home runs, to help Kansas City defea…
Alex Gordon drove in three RBIs to cap off a five-run 8th inning as the Royals beat Minnesota on Tuesday night.
Tampa Bay’s Wil Myers went 0-for-4 in his return to Kauffman Stadium, while Billy Butler homered and drove in three runs to help lead the Ro…
Greg Holland strikes out Ian Desmond to end the game and snap the Royals 7-game losing streak
KANSAS CITY, Mo. (AP) – Jordan Zimmermann rebounded from one of his worst career outings to go 7 2-3 strong innings, Ian Desmond hit his 18t…
A 7-run fourth inning fueled the Washington Nationals to an 11-10 win on Friday night against the Kansas City Royals
Conor Gillaspie hit the game-winning home run in the top of the 12th inning as the Chicago White Sox capped off a sweep of the Royals at Kau…
Dayan Viciedo hit a grand slam in the 4th inning as the White Sox captured back-to-back victories over the Royals at Kauffman Stadium.
Ervin Santana only allowed one earned run but the Royals offense couldn’t generate a run against Chicago’s starter John Danks.
Max Scherzer wins his ML-leading 18th game of the season Sunday afternoon.
Ft. Riley soldier Chris Nuyen is honored in Detroit prior to the Royals vs. Tigers match-up.
Miguel Cabrera hits a walk-off homer in the bottom of the 9th to help Detroit beat Kansas City
Eric Hosmer belted home runs in both games against the Tigers as the Royals swept Friday’s day-night doubleheader.
Danny Duffy made his second big-league start of the season and shut down the Detroit Tigers in game one of Friday’s doubleheader.
Wichita State product Andy Dirks went 4-for-4 with two doubles as the Tigers beat the Royals in the series opener at Comerica Park.


text:
1. Travel to Beijing. To Dubai. To Ukraine, to Lord Howe Island in Australia, to Belize, Vietnam. Travel to the cities were the air tastes of stars and humanity. Travel alone. You’ll meet people you’ve read about in books, the ones who say things like “oceans are God’s palms and you are his savior”.
2. Read poetry. Read sonnets, vignettes, haiku’s, limericks, free-verse. Rip out your favorite pages and hide them places. Put Shakespeare in the metro. Charles Bukowski confessions in church corridors. Anne Sexton in your mothers purse.
3. Do drugs. Smoke joints and eat acid and drink tea spiced with mushrooms. Write stories about dyed-red lizards and pastel oceans. Paint your liver, your lungs, your tongue. Listen to music and then realize how silence is the loudest sound of all."


Troy University’s women’s tennis team lost its second and third-straight conference matches, falling in a pair of 4-3 contests to No. 46 Georgia State and Georgia Southern.
While the matches were initially scheduled to take place in Boone, North Carolina, bad weather brought them to Atlanta, Georgia.
On Friday, April 8, the Trojans (11-7, 2-3 Sun Belt) played its first of two games in Atlanta against the Sun Belt powerhouse Panthers (11-5, 3-0 Sun Belt). Georgia State won without much difficulty at the No. 1 doubles spot and earned a tighter decision at No. 3 with a 7-5 victory, sealing the opening point.
The Trojans took the lead in singles play, with sophomore Nancy Karaky claiming her eighth-straight victory over Chiara Volejnicek 6 -2, 6-2, at the No. 4 singles spot. Sophomore Efriliya Herlina won a 6-1, 6-1 victory over Lara Vovk at the No. 5 singles spot.
Georgia State won the next three, solidifying their match win. They won straight sets at No. 6, three sets at No. 1 and straight sets at No. 3. Sophomore Sanae Ohta was the final scorer for the Trojans, winning 6-2, 4-6, 1-0 (10-5) at the No. 2 singles spot to mark her eighth-straight singles win.
On Saturday, April 9, Troy again fell 4-3, this time in a neutral-court match to Georgia Southern. While Troy’s previous two matches, including a loss to South Alabama at home on Wednesday, March 30, had ended in 4-3 contest losses, in this match the Trojans won the doubles point and let Georgia Southern take the win in four of six singles matches.
After No. 1 and No. 3 doubles wins, Troy lost three straight singles matches, falling behind 3-1. Karaky and Ohta, on the other hand, won their matches at No. 5 and No. 2. In the final match, freshman Luisa Ferrauti fell 6-4, 6-4 to Eagles senior Mary Phillips Smith in the No. 6 singles spot.
The Trojans wrap up their regular season on Friday, April 15, at No. 69 Florida State University. Start time in Tallahassee, Florida, is scheduled for 10 a.m.


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Work accident have incredibly decreased in number in the course of the most recent 15 years yet are still very predominant in fields like nursing, support business, development work, and so forth As per a news discharge distributed by the Bureau of Labor Statistics on November 4, 2020, the all-out number of work environment wounds among 100 full-time representatives stayed unaltered contrasted with 2019, at 2.8.
On the off chance that you experience a physical issue at the work environment or because of an immediate consequence of your business, you're qualified for a laborer's pay program, which incorporates mishap claims. This appears to be quite direct; however the connected high legitimate expenses deflect a ton of the harmed laborers from recording mishap claims. The "impossible to win no charge" strategy was acquainted with settle the issue of the harmed laborers to give them a reasonable possibility of remuneration regardless of whether they don't have any accessible assets for the forthright installment of lawful expenses.
On account of mishap claims, numerous specialists offer to take up the case following the "impossible to win no expense" strategy. In the event that a "impossible to win no expense" specialist doesn't win the case for you, you are not responsible to pay the lawful charges to the specialist. The specialist covers all lawful parts of your case under such an arrangement, facing the challenge of disappointment and not getting the preparing charges. As a trade-off for the conceivable danger, there is a triumph charge related with the case if the case is supported.
Under the "impossible to win no charge" strategy, you enter a restrictive expense concurrence with your specialist. This is a limiting composed authoritative archive that enrolls the subtleties of the arrangement between the petitioner and the legitimate delegate. According to the understanding under the said strategy, you're not obligated to pay the lawful expenses to your specialist if the case isn't supported and the pay isn't granted. In the event that the case is supported, a formerly concurred level of the granted remuneration is offered to the specialist. Prior to consenting to the arrangement, it is constantly encouraged to contemplate it completely and get some information about the level of the pay got and whatever other subtleties that could be of significance to the case.
What's in store when Filing a Claim
Record for a mishap guarantee quickly after the work mishap as time is of the pith in these cases. At the point when you contact the specialist fitting your personal preference, the lawful agent will turn out every single detail of your case prior to consenting to an arrangement with you. For the most part, specialists take up a case on the off chance that it has huge shots at being chosen in support of yourself as they are the ones facing the challenge of disappointment. The inquirer has nothing to lose here, generally talking, as they are not at risk to pay the lawful charges to the specialist in the event that the case isn't supported.
When recording a case with a "impossible to win no charge" specialist, unveil the subtleties relating to the mishap as a mishap guarantee is to a great extent subject to the state laws and the remuneration strategy your boss is advertising. After the important investigation, the lawful agent will talk about the subtleties of the restrictive expense concurrence with you in the event that they choose to take your case and deal with every one of the legalities of the case.
On the off chance that the case is endorsed, the specialist is qualified for a level of the remuneration that was commonly settled upon by the petitioner and the specialist in the contingent expense arrangement. Most of the legitimate expenses of the law office are remunerated by protection approaches.
In the event that a case isn't endorsed, the installment to be made to the law office relies upon the contingent charge understanding. In the event that the inquirer consented to pay the court costs and other various costs over the span of the case, they would need to bear those costs. The specialist isn't qualified for their handling expense as a component of a "impossible to win no charge" arrangement.
By and large, specialist’s endless supply of the case pays as the achievement expense for a case. This is liable to change contingent upon the specialists, the case, and the state laws. A few specialists might offer their administrations for lesser pay, yet different costs might be remembered for the arrangement. It is critical to completely examine the understanding and read the fine print prior to marking to know whether there are different costs rather than the handling expense that you are being considered responsible for.
If you've been injured in a work accident and want to get compensation, follow the injury specialists Solicitors’ guide to how to make a work accident claim.

domain: law


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Good on Curtis for calling some of the completely overblown rhetoric, talk of coup d'etat, banana republics and the assorted 1990's type "Rallies for Canadian Democracy"coming up this weekend.
I call bullshit, too.
Somehow equating a government losing a confidence vote in the House to be replaced by a governing coalition of opposition parties with real life coup d'etats just belittles very real and basic struggles that many face around the globe.
A look at the last couple of days in the news:
I'd love to sit some of these columnists and spin doctors down with people in some of these places and have them explain how exactly our situations even come close to comparing to each other.
What, someone might raise the gas tax on the vehicle you drive, the purchase price of which could be the equivalent of a couple of hundred people's annual salaries in some of these countries ? Yeah, poor unstable us. How can we possibly carry on.
It shows what columnists and spin doctors have set foot outside the country lately, aside from maybe a gated resort compound in
It's a bit embarrassing, really.

domain: news


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New film society seeks to educate Clark County on cinema, host film festival
Published 2:03 pm Monday, October 24, 2016
A new film society in Clark County is beginning to lay the groundwork for an ambitious goal: to host an independent film festival in 2018.
The Winchester-Clark County Film Society had it’s official ribbon cutting Thursday and is planning to hit the ground running, according to president and vice president Rick Baldwin and Kathy Lykins.
“Our goal is to, every month or other month host events and raise funds towards our 2018 goal to actually have an independent film festival in Winchester,” Baldwin said.
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The first event the society will host is a screening of “Night of the Living Dead” October 29 at the College Park Library, which will run concurrent with the nearby Halloween Fest and Haunted Swamp next door. The movie will start at 9 p.m., and admission is free with a donation to the film society of $3 per individual or $5 for two.
Lykins described the creation of the film society as “a dream come true,” saying she has wanted Winchester to host a film festival for several years because of the economic benefit it could bring the community.
“The whole reason I thought this was needed was I got into some crazy shows on Netflix … and I was just interested in the town I saw in those shows,” Lykins said.
That town was Covington, Georgia, which has played host to film crews for numerous productions

domain: entertainment


With us, you get more than just products. Companies are trending toward tailored drive packages and system solutions. We have the application knowledge you want and offer the process and logistics expertise you need.
From engineering to service – your added value for heavy industry
When systems manufacturers in heavy industries such as construction, mining or cement production talk about industrial gear units, they rarely talk about individual components. In most instances, our customers are looking for custom solutions with which they can quickly and reliably equip their systems and dependably get them up and running. This is why we at SEW-EURODRIVE consider ourselves problem solvers for all things drive technology – and for more than 80 years.
Our customers benefit greatly from the fact that we – unlike almost every other provider on the market – can provide a fully comprehensive drive technology portfolio from a single source. We rely not only on our own universal expertise in mechanical, electrical and electronic drive technology for your solutions. We also offer the necessary expertise in control technology, engineering tools and system software on the one hand, and machine safety and energy efficiency on the other.
As a skilled and reliable partner, we are always at your side
From initial planning and configuring to starting up and maintaining the industrial gear unit solution in your system. We offer:
- Compact drive packages and tailored, complete industrial gear unit systems
- Technically adept consulting from application specialists with years of experience
- Order-specific drive system engineering including integration into your system
- Quick availability of in-stock components near you thanks to our global production network
- Experienced service worldwide for quick availability and skilled assistance on site
Your consulting network
When our customers in heavy industry need industrial gear units, most projects are engineer to order (ETO) and assemble to order (ATO). Orders without a design stage tend to be in the minority since the systems are so complex. This is why, for us, problem solving begins with the sale. And since these kinds of projects are often of an international nature, our technically adept consultants, with years of industry experience, provide you with local application support on site – even in other countries.
Consistent consultingFrom our application specialists with years of experience who determine and meet all of your specific needs.
Joint conceptionThrough custom co-engineering, which our consultants complete with you at an early stage.
Global coordinationOn international projects with equally intensive consulting services that include your local end customers.
Your engineering network
Our engineering services range from order-specific drive package designing to specific solution integration configuring, or even planning an entire system upon request. Co-engineering is our priority throughout this process. We are not concerned with quick, short-term solutions, but with working with our customers to develop long-term strategies for their applications.
The knowledge gathered is networked by us in-house. To do this, we work internally with our own multi-product experts on topics such as tribology. This allows us to continue developing and learning from one another. The result is interdisciplinary expertise accumulated over years of experience that are utilize for the benefit of our customers on each new order – for tailored and custom-fit solutions.
Long-term solutionsSince our developments take into account what your application solution should look like in a few years.
Close co-engineeringSince a tailored and sustainable application solution is only possible by working closely with the customer.
Interdisciplinary expertiseThat allows you to benefit from our joint knowledge of all areas of our extensive drive technology.
Dependable commitmentSince we keep our promises and stick to the agreements we make together with the customer.
Your production network
As a global manufacturer of drive technology and drive automation, we are at home on five continents with our modern and powerful manufacturing and assembly plants. This means we are always near you or near your end customers. A close international network providing you both with experts for local application support and with in-stock components for quick, on-site replacement.
Our global production sites for industrial gear units
- Bruchsal, Germany: Production and assembly of series X and P industrial gear units
- Karkkila, Finland: Production and assembly of series X and MC industrial gear units
- Indaiatuba, Brazil: Production and assembly of series X, XP, P and MC industrial gear units
- Tianjin, China: Production and assembly of series MC, M1, ML, XP, P industrial gear units and segmented girth gears
- Pilsen, Czech Republic: Assembly of modified and standard gear units
- Lyman, USA: Assembly of series X, P and MC industrial gear units
- Santiago, Chile: Assembly of series MC industrial gear units
- Jurong, Singapore: Assembly of series MC industrial gear units
- Nelspruit, South Africa: Assembly of series X, P and MC industrial gear units
- Melbourne, Australia: Assembly of series X, P and MC industrial gear units
- Baroda, India: Assembly of series MC industrial gear units
Your service network
With SEW-EURODRIVE, you have the best hand in terms of service: A trailblazing, globally dense network of in-house service locations and industrial gear unit service hubs ensure you can always reach us and get the help you need on site. This worldwide local service provides you with service experts who have years of experience and application expertise – even when it comes to the other guy's products.
The Industrial Gear Unit Service from our service portfolio CDS® (Complete Drive Service) is extensive:
- Startup of industrial gear units and application solutions, incl. laser drive alignment and initial oil filling
- Inspection and maintenance, incl. gear unit diagnostic examination with an inspection scope and complete oil management
- Repair, incl. reworking of all housings and shafts or manufacturing of gearing components and shafts to template/drawing
- Retrofitting, incl. energy-efficiency aspects or precise reproduction of your components
- And much more
Service from a single sourceThrough intensive, local support from capable, in-house service experts with years of experience and application expertise.
Rapid on-site assistanceThanks to a global network of local service locations
Comprehensive serviceThat also integrates peripheral components such as couplings, oil coolers, sensors, motors and products from other manufacturers.
Areas of application
Your areas of application for services and solutions
Our added value and services in all things related to industrial gear unit solutions are always available wherever heavy loads are being moved at high torque.
Materials handling tasks"
- Construction and construction materials industries
- Timber industry
- Steel industry
- Chemical industry
- Recycling industry
- Cargo (ports, depots, airports, etc.)
- Sugar industry (sugar beets, cane sugar)
- Tobacco industry
- Nautical: capstans, windlasses
- Construction and mining: winches and more
Agitating, mixing, aerating:
- Water treatment
- Chemical industry
- Food industry and more


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- THE MAGAZINE
- CATEGORY FOCUS
- BEVERAGE R&D
Articles Tagged with ''2 Gingers''
Deerfield, Ill.-based Beam Inc. added the 2 Gingers brand to its Irish whiskey portfolio. Additionally, the company announced that Kieran Folliard, the founder of 2 Gingers, will become Beam’s chief Irish whiskey ambassador in the United States.


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A Design That Delights The Eye
What you want; why you want it; the results you hope for; the aesthetics of your space; what’s possible given room dimensions and shape – we dig deep into these elements to offer you a range of creative, custom-designed options. We’ve even done what others said was impossible.
With your architect, we ensure the details fit: location of outlets, height of the TV off the floor and other important visual touches.
The Right Equipment
Without a showroom, we’re not tied to any manufacturers: we make unbiased decisions about items that match your vision and your finances. You get exactly the right equipment. Nothing more. Nothing less.
At Utopia, we go out of our way to provide exceptional service. We’re passionate about our work, and we’re up to date on the latest options available. When you work with us, we’ll take the time to listen to your needs, adhere to your budget, and install the system you’re looking for.
We handle your project from concept to design to the finished product. We are meticulous in our attention to detail and quality of our installations. You can count on us to deliver a top-quality job that will provide lasting enjoyment for years to come.
We all love modern, ultra-high quality visual and auditory experiences. The technology has become so advanced that the quality can literally take your breath away. We are proud of the systems that we design and install, but what we love the most is bringing enjoyment to our customers’ lives.
Installation That Works Right From The Start
There’s more to audio video systems than simply choosing the right equipment. Correct audio video installation, design and accurate programming are critical; a well thought out wiring plan meets your present needs yet allows for future changes and upgrades. We engineer, implement, and test everything so you avoid future problems.
Of course, the latest gadgets are no use if those less technically gifted can’t use them properly. With an audio video installation by Utopia, that won’t happen.
Service That Brings A Smile To Your Face
Lots of questions pop up before, during and after an upgrade or a new audio video installation. Call us at any stage of the process. We return your calls the same day. No long waits for maintenance or technical support after installation either: we’re at your home or troubleshooting with you on the phone within a day or two.
And speaking of details: we give you as many as you want – from a simple itemized list, to color-coded wire diagrams with photos, or video of your project as it unfolds.

domain: design


Company Cotton™ Sailing Regatta Percale Duvet Cover Set
We adore all things nautical, and this duvet cover and sham set are no exception. Showcasing a regatta of colorful sailboats, the original print is reproduced on pure cotton percale for a cool, crisp hand and light, airy texture.
Duvet Cover Sets Include:
- Twin duvet cover set includes: 1 Twin duvet cover and 1 Standard sham
- Twin XL duvet cover set includes: 1 Twin XL duvet cover and 1 Standard sham
- Full duvet set includes: 1 Full duvet cover and 2 Standard shams
- Queen duvet set includes: 1 Queen duvet cover and 2 Standard shams
- King duvet set includes: 1 King duvet cover and 2 King shams
- Sails are up as this colorful regatta races across these crisp percale duvet cover and sham set
- 200-thread count
- 100% combed cotton percale
- Reverses to same print
- Duvet cover has a button closure
- Features four interior corner ties that attach to corner loops on our basic bedding comforters to secure both in place
- Pillow sham has a back closure with 6 in. overlap to keep your pillow in place
- Additional shams are sold individually
- Entire collection includes a sheet set, a duvet cover set, pillowcases, shams, and shower curtain, each sold separately
- Twin: 70 in. x 90 in.
- Twin XL: 70 in. x 96 in.
- Full: 80 in. x 90 in.
- Queen: 90 in. x 96 in.
- King/Cal. King: 108 in. x 96 in.
- Standard: 20 in. x 26 in.
- King: 20 in. x 36 in.
- Euro: 26 in. x 26 in.
- Machine wash gentle cycle with like colors
- Use only non-chlorine bleach as needed
- Tumble dry low
- Warm iron as needed
Combed Cotton - Removing short fibers and impurities from harvested cotton, makes combed cotton extremely soft and strong. It is the highest quality cotton available and the only cotton used at The Company Store.
Percale - Cool, crisp, and lightweight, percale is a plain-weave fabric that’s smooth to the touch and perfect for people who get warm while sleeping. Percale resists pilling and gets better over time – becoming even crisper and cooler the more you wash it.
Thread Count - Thread count is the number of horizontal and vertical threads per square inch of fabric. The higher the thread count, the tighter the weave of a sheet. However, thread count alone is not an indicator of quality—the quality of the material is more important. The Company Store goes the extra mile using only premium fabrics to create exceptional products.
Awards & Certifications
Having the STANDARD 100 by OEKO-TEX® label assures you that an independent certification has been conducted on each component of this product and been tested against a list of more than 350 harmful substances according to strict scientific criteria that stays ahead of global legal regulations. Test criteria considers all the ways a substance can be absorbed into the body, including through skin contact and respiration to make sure you and your family are safe.
Q & A


Background: Stability of power supply is one of the main problems affecting the performance
and continuity of medical equipment in a developing country. Gamma camera is one of medical equipment
uses radio isotope for patient imaging.
Objective: There are various parameters degraded image quality in gamma camera. This paper discusses
the effect of stability of power supply on image performance.
Methods: To perform this work a total of 125 intrinsic uniformity tests for a gamma camera connected
to stable power supply and a total of 125 intrinsic uniformity test for a gamma camera connected to an
un-stable power supply were used.
Results: The integral uniformity (central and useful field of view) and differential uniformity (central
and useful field of view) were calculated using 99mTc point source.
Conclusion: The result shows that the quality of image degraded in unstable power supply; on the other
hand gamma camera connected to the supply via uninterrupted power supply (UPS) was stable and
gives highly uniform image in both central and useful field of view.