Our Body’s Own Natural Immunological Battle Against Cancers

 

 In the body it was found that micro cancers or cellular cancers can already persist for years before cancer becoming clinically apparent. This latency period is influenced by the slow growth of cancer cells, immune surveillance, dormancy, genetic changes, and the span several years to decades.

It is possible for scientists to develop therapeutic strategies that mimic the body's own natural immunological systems to fight cancer.

Before that, let’s have a look at how the body naturally fights micro cellular cancers all the time. The time period before micro cellular cancers lurking in the body before they manifest themselves into full grown clinical cancer may take as long as 30 – 50 years, thanks to our wonderful immunological surveillance and its constant attack.  

The immune system against cancers is slightly different from those for infectious diseases since the body has to deal with its own malignancy, and not foreign agents from outside. Nevertheless, the same immune system plays a crucial role in recognizing and eliminating cancer cells through a process known as cancer immunosurveillance.

This involves both innate and adaptive immune mechanisms designed to detect and destroy abnormal cells that may become cancerous. The immunological mechanism against cancer is its innate immune response by releasing natural killer (NK) cells. These cells can recognize and kill cancer cells without prior sensitization. They identify stressed or abnormal cells by the absence of MHC class I molecules, which are often downregulated in cancer cells. The way NK cells do this is to release perforin and granzymes, which induce apoptosis (programmed cell death) in the target cell. Tumour-Associated Macrophages (TAMs) are also released.  These can have dual roles. M1 macrophages are pro-inflammatory and can kill tumour cells, while M2 macrophages may do the opposite by promoting tumour growth and suppressing the immune response.

The body response to cancer also involves phagocytosis by macrophages and cytokine production. Macrophages can engulf cancer cells and release cytokines that stimulate other immune cells. There are also the dendritic cells (DCs) and its antigen presentation where the DCs capture tumour antigens and present them to T cells, initiating an adaptive immune response. Activation of T Cells causes the presentation of antigens along with costimulatory signals for DCs to activate T cells to target and kill cancer cells. Furthermore, the body also has a complementary system that causes direct killing by directly lysing the tumour cells through the formation of the membrane attack complex (MAC). These include:

Opsonization to enhance phagocytosis of cancer cells by coating them with complement proteins.

Adaptive immune response to cancer T Cells involving cytotoxic T lymphocytes (CTLs or CD8+ T Cells) works by:

Recognition of tumour antigens causes CTLs recognition of specific antigens presented by MHC class I molecules on cancer cells that activate the killing mechanism.  Once activated, CTLs release perforin and granzymes that induce apoptosis in cancer cells.

Memory T Cells provide long-term immunity and can quickly respond to cancer cells if they reappear.

Helper T Cells (CD4+ T Cells) are there to support CTLs and B Cells. Helper T cells produce cytokines that aid the activation and proliferation of CTLs and B cells.

Regulation of immune response helps maintain a robust immune response against cancer cells. B cells can produce antibodies specific to tumour antigens.

Antibody-mediated immunity coats cancer cells through opsonization marking them for destruction by phagocytes.

NK cells and other effector cells can recognize antibody-coated cancer cells and kill them through antibody-dependent cellular cytotoxicity (ADCC).  

The interaction between the immune system and cancer cells can be described by the concept of immunoediting, which includes three phases:

1. Elimination:

The immune system detects and destroys cancer cells before they can establish a tumour.

2. Equilibrium:

Some cancer cells may survive initial immune attacks and enter a state of dormancy. During this phase, the immune system controls tumour growth, but the cancer cells are not completely eradicated.

3. Escape:

Cancer cells can acquire mutations that allow them to evade the immune system, leading to tumours progression and metastasis. Mechanisms of immune evasion include:

Downregulation of MHC molecules reduces the ability of T cells to recognize cancer cells by secretion of immunosuppressive molecules such as TGF-beta, IL-10, and VEGF, which inhibit the function of immune cells.

Expression of immune checkpoint molecules such as PD-L1, which interact with inhibitory receptors on T cells (like PD-1) to suppress their activity.

In terms of cancer treatment other than by surgery, chemotherapy, and radiation scientists having learnt these strategies briefly explained above in this essay, they  can now consider using cancer immunotherapy to mimic the body's own ability to fight cancer.

In order to enhance the immune system's ability to fight cancer, scientists have developed several immunotherapeutic strategies to help mimic the body These are:

1. Immune Checkpoint Inhibitors such as:

CTLA-4 Inhibitors: Block the CTLA-4 receptor on T cells, enhancing their activation.

PD-1/PD-L1 Inhibitors: Block the interaction between PD-1 on T cells and PD-L1 on cancer cells, preventing immune suppression.

2. Adoptive Cell Transfer:

CAR-T Cell Therapy: T cells are extracted from the patient, genetically engineered to express chimeric antigen receptors (CARs) that specifically target tumour antigens, and then reinfused into the patient.

3. Cancer Vaccines:

Preventive Vaccines: Such as the HPV vaccine, which prevents virus-induced cancers.

Therapeutic Vaccines: Aim to stimulate an immune response against existing tumours by introducing tumour antigens.

4. Cytokine Therapy:

Interleukins and Interferons: Enhance the proliferation and activation of immune cells.

5. Monoclonal Antibodies:

Targeted therapy involves using monoclonal antibodies that can be designed to target specific antigens on cancer cells, marking them for destruction or delivering cytotoxic agents directly to the tumour.

The immune system's ability to detect and eliminate cancer is complex and involves a coordinated effort between innate and adaptive immunity. Advances in understanding these mechanisms have led to significant developments in cancer immunotherapy, offering new hope for effective cancer treatment.

Lim ju boo 

Our Wonderful Immunological System

 

In my last article I wrote about

“The Healing Properties of Our Body. Is Prevention Better than Cure?”

here:

https://scientificlogic.blogspot.com/2024/05/the-healing-properties-of-our-body-is.html

I mentioned about injuries such as bleeding, wounds, and fractures. It is not always we are injured and traumatised. But what we are facing every second, every minute in our lives are pathogenic organisms from the environment. These are far more threatening to our existence than occasional injuries such as cuts, bruises, and fractures from accidents. I thought it is only fair I should give priority to discuss a little bit how our body defend itself against invading pathogenic organisms from outside and within our bodies.  This is “Our Wonderful Immune System”. Later, perhaps I may deal with an internal threat from our own cells - cancer. But let me deal with infection first.  

The human body has a highly sophisticated and multi-layered defence system to protect itself against infections caused by pathogens such as bacteria, viruses, fungi, and parasites. This defence system can be broadly categorized into innate (nonspecific) and adaptive (specific) immunity. We shall briefly outline how each component works:

First, we have this innate immunity which can be classified as physical and chemical barriers. The skin for instance acts as a physical barrier preventing the entry of pathogens. It also produces antimicrobial proteins and peptides. Mucous membranes line the respiratory, gastrointestinal, and genitourinary tracts, trapping pathogens in mucus.

Secretions such as saliva, tears, and mucus contain enzymes like lysozyme that break down bacterial cell walls. Then there is this stomach acid where the acidic environment (low pH) destroys many ingested pathogens. Cilia which are tiny hair-like structures in the respiratory tract that move mucus and trapped pathogens out of the lungs.

Secondly, the body is also equipped with cellular defences that are the phagocytes, the white blood cells such as neutrophils and macrophages that engulf and digest pathogens. These phagocytes are made up of neutrophils which are the most abundant white blood cells that respond quickly to infections, the macrophages found in tissues and organs. They ingest pathogens and dead or dying cells.

Comes next the natural killer (NK) cells that destroy infected or cancerous cells by releasing cytotoxic granules that induce apoptosis (cell death). The blood also has the dendritic cells. These cells act as antigen-presenting cells that capture antigens and present them to T cells, initiating the adaptive immune response.

That’s not all. We have the inflammatory response that initiates inflammation, a process that isolates and limits tissue damage and infection. It involves vasodilation, an increased blood flow to the affected area, causing redness and heat. Increased permeability in the area allows immune cells and proteins to enter tissues, causing swelling. Like an army, there is also phagocyte recruitment that attracts immune cells to the site of infection to eliminate pathogens.

Then other components that come into action are the antimicrobial proteins which are a complement system where a group of proteins enhance the ability of antibodies and phagocytic cells to clear pathogens.  Added to that are the opsonization which means coating pathogens to make them more recognizable to phagocytes. That’s not all. There is this thing called Membrane Attack Complex (MAC). These form pores in the membranes of pathogens, leading to their lysis. Comes next the interferons which are proteins produced by virus-infected cells that help protect neighbouring cells from viral infection.

Next in line we have the adaptive immunity that involves specificity and memory. Here lymphocytes, the primary cells are involved in adaptive immunity, involving B cells that produce antibodies that bind to specific antigens. Upon activation, they differentiate into plasma cells that produce large quantities of antibodies which we shall classify them shortly.

The immunological system is also armed with memory B cells. These cells have memories that provide long-lasting immunity by remembering past infections. Comes another type or army – the T cells. They are involved in cell-mediated immunity. There are two main types, the helper T Cells (CD4+) where they activate B cells and other immune cells by releasing cytokines. The immune system has yet another type of army we call them as cytotoxic T Cells (CD8+). They directly kill infected or cancerous cells.

Having said all that, next comes the antigen presentation that is made of a major histocompatibility complex (MHC). These are molecules that present antigens on the surface of cells. Immunologists group them as MHC Class I, found on all nucleated cells, present antigens to cytotoxic T cells. MHC Class II are found on antigen-presenting cells (APCs) like dendritic cells, macrophages, and B cells, present antigens to helper T cells.

That’s not all. The immunological system also has the Clonal Selection and Expansion. When a lymphocyte recognizes its specific antigen, it undergoes clonal expansion, producing many identical cells that can respond to the pathogen. They have the effector cells that actively respond to the infection. The memory cells then provide a rapid and robust response if the pathogen is encountered again.

Having explained all that, comes the antibodies most people have heard of.

Antibodies have a structure that consists of variable regions that bind specific antigens and constant regions that determine the class of the antibody. Their functions are:

Neutralization that blocks pathogens or toxins from interacting with host cells. Opsonization that marks pathogens for phagocytosis. Complement Activation that triggers the complement system leading to pathogen destruction.

Agglutination then clumps pathogens together for easier removal. There are many types of antibodies. Antibodies, also known as immunoglobulins (Ig), play a crucial role in the immune defence against pathogens and abnormal cells. There are five main classes of antibodies, each with specific functions and characteristics:

Classes of Antibodies are:

IgG (Immunoglobulin G). They are the most abundant antibodies in the blood and extracellular fluid. They provide long-term protection and memory. They are capable of crossing the placenta to provide passive immunity to the foetus.

Involved in opsonization, neutralization of toxins and viruses, and activation of the complement system.

IgA (Immunoglobulin A):

Functions:

IgA are found in mucous membranes lining the respiratory and gastrointestinal tracts, as well as in saliva, tears, and breast milk. They protect the mucosal surfaces by preventing the attachment and entry of pathogens. They play a role in mucosal immunity.

IgM (Immunoglobulin M):

Functions:

IgM is the first antibody produced in response to an infection.

It is found in the blood and lymphatic fluid. It is effective at forming antigen-antibody complexes and activating the complement system. It plays a crucial role in the primary immune response.

IgE (Immunoglobulin E):

Functions:

IgE is involved in allergic reactions and responses to parasitic infections. It binds to allergens and triggers histamine release from mast cells and basophils. It mediates immediate hypersensitivity reactions.

IgD (Immunoglobulin D):

Functions:

IgD presents in small amounts in the blood and on the surface of B cells. It is involved in the activation and regulation of B cells during the immune response. Its precise role is less well understood compared to other antibody classes.

Antibody Subclasses. Some antibody classes have further subclasses that provide more specialized functions. For example, IgG Subclasses are:

IgG1: Most abundant subclass, effective in opsonization and complement activation.

IgG2: Involved in responses to bacterial polysaccharides.

IgG3: Highly effective in complement activation.

IgG4: Involved in responses to allergens and chronic infections, and less effective in complement activation.

IgA Subclasses:

IgA1: Found primarily in serum.

IgA2: Found primarily in secretions at mucosal surfaces.

Specific Antibodies:

In addition to the general classes and subclasses, there are specific antibodies used in clinical and therapeutic contexts. These are often monoclonal antibodies, designed to target specific antigens associated with diseases. Some notable examples include:

Rituximab (anti-CD20): Used to treat certain autoimmune diseases and cancers, particularly B-cell non-Hodgkin lymphomas.

Trastuzumab (Herceptin, anti-HER2/neu): Used to treat HER2-positive breast cancer.

Pembrolizumab (Keytruda, anti-PD-1): Used in cancer immunotherapy to block the PD-1 pathway and enhance the immune response against tumours.

Infliximab (Remicade, anti-TNF-alpha): Used to treat autoimmune diseases such as rheumatoid arthritis and Crohn’s disease.

Omalizumab (Xolair, anti-IgE): Used to treat allergic asthma and chronic spontaneous urticaria.

These monoclonal antibodies are specifically engineered to target particular molecules involved in disease processes, and they represent an important application of antibody technology in modern medicine.

Integration of Innate and Adaptive Immunity:

·         Cytokines and Chemokines: Small proteins released by cells that mediate and regulate immunity, inflammation, and haematopoiesis. They help in the communication between innate and adaptive immune responses.

·         Antigen-Presenting Cells (APCs): Such as dendritic cells and macrophages, bridge the innate and adaptive immune systems by presenting antigens to T cells.

The coordination and interplay between these various mechanisms ensure that the body can effectively detect, respond to, and remember pathogens, providing both immediate and long-term protection against infections.

We can see how wonderful our Immunological System works for us. In fact, all their components and subcomponents are active all the time, every second, every minute in our entire life defending us silently against infection without us knowing it.

And yet, doctors unnecessarily prescribe all those antibiotics for us for every infection, causing an abuse in antibiotics resulting in a lot of antibiotic strains of bacteria that have developed resistance to antibiotics. This resistance can be to a single antibiotic or multiple antibiotics, making infections caused by these bacteria more difficult to treat when in truth the body by itself can easily handle most of the infections.   

We shall talk about this in another article.

“A True Doctor is One Who Teaches, The Best Healer is Your Own Body” (Motto of my blog)

Lim ju boo 

 

 

 

The Healing Properties of Our Body. Is Prevention Better than Cure?

 

The British idiom “prevention is better than cure” or “an ounce of prevention is worth a pound of cure” in the US is often quoted elsewhere throughout the world.

Cambridge dictionary defines this to mean:  

“it is better to stop something bad from happening than it is to deal with it after it has happened”.

This meaning applies generally to healthcare whether or not it would be better to prevent a disease from occurring, than to look for a cure for it. In other words, is preventive medicine better than curative medicine? Let’s have a look.

Determining whether curative or preventive medicine is "better" or "more effective" depends on the context, including the type of disease, the healthcare system, and societal goals. Both have distinct roles and benefits in healthcare. The advantage in preventive medicine is that it reduces disease incidence by adopting preventive measures, such as vaccinations, health education, and lifestyle changes, reducing the incidence of diseases, leading to healthier populations. It is also more cost-effective in preventing diseases than trying to treat them. For instance, vaccines are generally much cheaper to prevent than treating diseases like measles or polio. It also improves the quality of life by avoiding the pain and disability associated with diseases. Regular screenings and lifestyle changes can prevent chronic diseases like diabetes and heart disease. Furthermore, preventive medicine lowers healthcare burden by reducing the number of people who get sick, preventive medicine decreases the burden on healthcare systems, allowing resources to be allocated more efficiently. Besides that, we also have long-term benefits where preventive interventions can have long-lasting effects, leading to healthier future generations through practices like maternal health education and early childhood interventions, adopting good dietary habits, exercise, and incorporating public health policies such as clean water, anti-smoking campaigns.

Curative medicine on the other hand too has its advantages by directly addressing Illness. Curative medicine focuses on diagnosing and treating diseases once they occur, which is essential for acute and chronic conditions that cannot be prevented. Firstly, curative medicine provides immediate relief from symptoms and can be lifesaving, particularly in emergency situations, surgeries, and treatments for severe infections. The advanced medical interventions include surgeries, chemotherapy, and targeted therapies that can cure or manage conditions effectively. Medical intervention is critical and necessary for complex diseases that are not easily preventable, such as genetic disorders, certain cancers, and autoimmune diseases.

Curative medicine such as the use of antibiotic treatments, surgeries, chemotherapy, dialysis, and intensive care drives medical research, innovation and technological advancements that can eventually inform preventive strategies as well.

The advantage in preventive medicine is its effectiveness in reducing overall disease burden. Vaccinations and public health measures for example can prevent large-scale outbreaks and control endemic diseases. Preventive measures are also cost-effective by saving more money in the long run by reducing the need for expensive treatments and hospitalizations. Preventive care has long-term and a broader impact on population health and can lead to systemic improvements in public health and longevity.

Comparatively, curative medicine has an immediate and specific impact on treatment outcome. It is indispensable for treating existing illnesses and managing conditions that cannot be prevented. It provides necessary interventions for acute and chronic conditions that, if left untreated, could be fatal or severely debilitating.

Both has their advantages. The most effective healthcare system integrates both preventive and curative approaches. Preventive medicine reduces the incidence of diseases and promotes overall health, while curative medicine ensures that those who do fall ill receive the necessary treatment. A balanced approach ensures comprehensive care, maximizes health outcomes, and optimizes resource use.

Thus, neither approach can be considered universally superior; instead, their effectiveness is maximized when used complementarily, tailored to individual and population health needs.

Having explained all that, it can also be another way. Often it is also unnecessary to treat, worse still over treat a disease with all kinds of drugs and medications without even allowing the body to naturally heal itself. Let’s have a look at how the body heals itself naturally without interference.

The human body has remarkable self-healing abilities, which can often eliminate the need for medication or surgery. Here are several examples of how the body can heal itself and the mechanisms involved:

Cuts and Bruises can heal themselves through natural processes such as haemostasis. When a cut occurs, blood vessels constrict, and clotting begins to stop the bleeding. Then there may be inflammation. When this occurs white blood cells move to the injury site to fight infection and remove debris. There is then proliferation by new tissue and blood vessels to help the wound start to close. After this there is remodelling where the wound matures, and the new tissue strengthens and integrates with the surrounding tissue. The healing time for small cuts can heal within a few days to a week, depending on their severity.

In the event of bone fractures, the body responds by inflammation and pain to rest the area.  Blood clots form around the fracture to stabilize the bone. Then there is soft callus formation where cartilage forms around the fracture as a temporary fix. After that there is hard callus formation where the cartilage is replaced by a hard bony callus. Following that healing process, remodelling takes place.  The bone is reshaped and strengthened over several months to years. The healing time for fractures can take several weeks to months to heal, depending on the bone and the severity of the fracture.

In the event of minor infections, the immune response is triggered.  The immune system detects pathogens and mounts an attack using white blood cells, antibodies, and other mechanisms. For example, a mild fever can enhance the immune response and inhibit pathogen replication. There is then resolution where the body clears the infection, and the immune system retains a memory of the pathogen.

The healing time for minor infections can resolve within a few days to a week. We then have muscle strains and sprains. The healing process involves inflammation, swelling and redness that occur as the body responds to the injury. During the repair mechanism, muscle fibres regenerate and scar tissue forms. This is followed by remodelling where the muscle tissue strengthens and adapts to prevent future injury. The healing time and recovery can take a few days to several weeks.

The mechanism of self-healing normally involves pain over the area to enforce rest.  The inflammation is the body's initial response to injury or infection. It involves the release of signalling molecules like cytokines and chemokines, which attract immune cells to the site of injury to begin the healing process. This is followed by cellular regeneration where certain tissues, like skin and the liver, have a high capacity for cellular regeneration. Stem cells in these tissues can differentiate into various cell types needed for repair.

The body is designed and equipped with an immune system. The immune system identifies and eliminates pathogens, clears out dead or damaged cells, and facilitates tissue repair. It involves clotting and coagulation. When blood vessels are damaged, the body initiates a cascade of events that result in the formation of a blood clot to stop bleeding and begin the repair process.

Over time, the body remodels and strengthens new tissue to restore normal function. This can involve the deposition of collagen, removal of excess cells, and integration of new tissue with existing structures.

Briefly summarized, while the body has impressive self-healing capabilities, the effectiveness and speed of healing can be influenced by factors such as the severity of the injury, age, overall health, and presence of underlying conditions. In some cases, but rarely, medical intervention is necessary to support or enhance the body's natural healing processes, especially for severe injuries, infections, or chronic conditions. However, understanding and supporting the body's innate ability to heal can often reduce the need for unnecessary medication or surgery. 

Most of the diseases seen these days are chronic diseases such as type 2 diabetes, heart disease, stroke, lung cancer, colorectal cancer, gout and arthritis, osteoporosis, and even depression to name a few are diseases of unhealthy lifestyles. How is it possible to treat these diseases due to damaging nutrition, sedentary lifestyles, obesity using chemical drugs without wanting to remove their root causes? The root cause through education, counselling and lifestyle modification are never addressed by the doctor except prescribing all kinds of unnecessary drugs for the patient to swallow the easy, short-cut way. How is the patient going to find a permanent cure if all these lifestyle root causes are never addressed? 

Similarly, it is very unfortunate when a patient sees a doctor for a minor injury, a fever or a minor infection that is not life-threatening; he is also being unnecessarily overtreated with all kinds of chemical drugs. The doctor does not even allow the chance for Nature to do her own work for which the body is designed. This unnecessary interference with all kinds of chemical drugs weakens the body’s own immunological, defence, healing and adaptation ability to be more resilient to future disease, infections and injury an area called biological adaptation, evolutionary biology or Darwinism medicine which I am familiar with after reading for a postdoctoral course at the University of Cambridge.

I think the body is specially designed this way to support our continuous survival under adverse challenging conditions and environment. A lot of people are being injured and insulted constantly by the external environment from pathogens to radiation and free radicals. These events occur every second of our lives. Without us knowing it, the body silently defends us, and the repair mechanisms are triggered off all the time.

In this way we survive the odds as we adapt. Nature knows best and we need to respect her healing powers. She is the best Healer to our body, definitely not the doctor for which I am one.  

Lim jb 

A Brief Understanding How Diseases are Diagnosed, Treated and their Outcome.

 

Good morning to you dear Allan Lee.

Thank you for asking in the comment column the methods we use in the examinations, investigations, treatment of diseases and their outcome. Thank you, Dr Jasmine Keys, too for your other discussions in our WhatsApp chat group.

Firstly, to all who are non-medical friends, it took us at least 5 years to learn medicine in a medical school to earn an MD or an MBBS degree. Thus it is almost impossible to describe all the methods, treatment a doctor or a clinician uses, and how diseases are classified. This learning period also applies to all other alternative, complementary or integrated systems of medicine, not just in conventional allopathic medicine. Medicine is quite complicated.

But what I can do for you Allan and other readers in my blog is give you a very fast run-down on all the diagnostic methods, treatment regimen and protocol, outcome of investigations and treatment a physician, a surgeon or other medical specialist may use. After that, I shall then give a brief classification of diseases.

This will not just answer your question but also provide a general idea on the methods used in medicine for the information of non-doctors and other readers. Is that okay?

Let us have a look at how diseases are investigated and diagnosed.

But before I proceed, straight away I need to emphasize it is not necessary for a doctor to do all investigations I am going to describe below for him to come out with a diagnosis. Most of these examinations, especially lab tests and radiological imaging are not necessary. I need to stress that a skilful doctor does not require all these tests. If he (including she) is a good clinician, he would use his clinical acumen and judgement to come out with an accurate diagnosis without any lab or axillary support. In other words, a skilful doctor is a good diagnostician. Imagine a doctor working in the field isolated from all facilities, or one who works in a remote rural environment where lab, radiological or other support diagnostic facilities are unavailable. What is he going to do then without them? 

He must depend entirely on what the patient tells him, the patient's history, and the presentations (signs and symptoms) of the disease. We cannot depend on all these support diagnostic facilities I am going to briefly list  below.  Then we are not a good diagnostician with good clinical acumen. 

A doctor depending entirely on lab support is going overboard with diagnosis which in most cases are not necessary. The most important probably is taking a good medical history of the illness, conducting an appropriate clinical examination, and looking for signs and symptoms presented. We would already be able to come out with the diagnosis unless of course the disorder is asymptomatic such as diabetes, high blood pressure. In that case we need lab support to investigate and to measure.

Lab, radiological and other diagnostic support are only necessary for differential diagnosis when the disease presentations are not clear cut, mimic another disease or with mixed complications with other disorders. Most cases are quite clear cut from what the patient tells the doctor, together with further questioning by the doctor, and perhaps some simple examinations such as listening to body sounds (auscultation), palpations, and percussions. 

 

We shall now proceed to describe other support diagnostic examinations and tests available.  

Diagnosis:

The diagnosis of diseases involves a multifaceted approach that includes clinical examinations, radiological imaging, laboratory investigations, and other specialized diagnostic methods. The clinical examinations include history taking by gathering information about the patient's past illnesses, surgeries, medications, allergies, and family history. Then the patient’s social history may be needed to gather information about lifestyle factors such as smoking, alcohol consumption, diet, and occupational hazards.

We will then go into the symptom analysis where we questioned the patient about the nature, duration, intensity, and progression of symptoms.

After history taking, we do a physical or clinical examination by inspection and visual examination of the body for signs such as rashes, deformities, or swelling. We do a palpation using hands to feel for abnormalities such as lumps, tenderness, or organ enlargement. We then do a percussion by tapping on body surfaces to detect abnormalities in underlying structures based on the sound produced. If necessary, we listen to internal body sounds, such as heart, lung, and bowel sounds, using a stethoscope. This is called auscultation.  The doctor may look at vital signs such as measuring blood pressure, heart rate, respiratory rate, and temperature.

If necessary, we may need radiological investigations such as:

·         Chest X-ray: To detect lung conditions like pneumonia, tuberculosis, and lung cancer.

·         Abdominal X-ray to identify obstructions, perforations, and some kidney stones.

·         Skeletal X-ray may be needed to diagnose fractures, dislocations, and bone infections.

More advanced radiology may also be used such as:

·         Computed Tomography (CT) Scan may be requested to provide detailed cross-sectional images of body structures, useful for detecting tumours, internal injuries, and infections.

·         Magnetic Resonance Imaging (MRI) using magnetic fields and radio waves to produce detailed images of organs and tissues, particularly useful for brain, spinal cord, and musculoskeletal conditions.

·         Ultrasonography uses ultrasound that uses high-frequency sound waves to create images of internal organs, commonly used in obstetrics, cardiology, and abdominal investigations.

We also have nuclear medicine scans, for example:

·         Positron Emission Tomography (PET) Scan.

We use this to detects metabolic activity and is useful in cancer diagnosis. Then we also have bone scan for us to detect abnormalities in bone metabolism. This is useful in diagnosing bone cancer and infections.

Most used are all those laboratory investigations. Let us summarise their long list here without unnecessary details:

1. Blood Tests:

·         Complete Blood Count (CBC): Measures different components of blood, including red and white blood cells, haemoglobin, and platelets.

·         Blood Chemistry Panel: Assesses electrolyte levels, kidney function (BUN, creatinine), and liver function (AST, ALT).

·         Blood Glucose: To diagnose diabetes.

·         Lipid Profile: Measures cholesterol and triglycerides levels.

2. Urine Tests

·         Urinalysis: Detects urinary tract infections, kidney disease, and metabolic conditions like diabetes.

·         Urine Culture: Identifies bacteria causing infections.

3. Microbiological Tests

·         Cultures (Blood, Sputum, Throat, Stool): Identify pathogens causing infections.

·         Sensitivity Testing: Determines the susceptibility of bacteria to antibiotics.

4. Immunological Tests

Antibody Tests: Detects antibodies against infections like HIV, hepatitis, and autoimmune diseases.

Antigen Tests: Identifies specific antigens related to infections or conditions.

5. Genetic Testing

Karyotyping: Examines chromosomes for genetic abnormalities.

PCR (Polymerase Chain Reaction): Detects specific genetic sequences associated with diseases.

Other Diagnostic Methods Specialist Clinicians may use include:

1. Endoscopy

Gastroscopy: Visual examination of the stomach and upper GI tract.

Colonoscopy: Visual examination of the large intestine.

Bronchoscopy: Examination of the airways and lungs.

2. Electrodiagnostic Tests:

Electrocardiogram (ECG): Measures electrical activity of the heart, useful in diagnosing arrhythmias and myocardial infarction.

Electroencephalogram (EEG): Records electrical activity of the brain, used in diagnosing epilepsy and other neurological conditions.

Electromyography (EMG): Assesses the electrical activity of muscles, helpful in diagnosing neuromuscular disorders.

3. Biopsy

·         Fine Needle Aspiration (FNA): Extracts cells for examination, often used for lumps or masses.

·         Core Needle Biopsy: Removes a small cylinder of tissue for analysis, commonly used in breast and prostate examinations.

·         Excisional Biopsy: Surgical removal of a lump or suspicious area for examination.

4. Functional Tests

·         Pulmonary Function Tests (PFTs): Measure lung function, used in diagnosing respiratory conditions like asthma and COPD.

·         Cardiac Stress Test: Assesses heart function under stress, useful in diagnosing coronary artery disease.

5. Imaging-Guided Procedures

·         Fluoroscopy: Real-time moving X-ray images, often used during diagnostic and therapeutic procedures.

·         Image-Guided Biopsy: Uses imaging techniques (CT, ultrasound) to guide biopsy needles to precise locations.

Advanced and Specialized Diagnostic Techniques

1. Molecular Imaging

PET-CT scan: Combines PET and CT imaging to provide detailed information on both structure and metabolic activity.

2. Cytogenetic Analysis

Examines chromosomes for genetic conditions, often used in prenatal diagnosis and cancer.

3. Flow Cytometry

Analyses the physical and chemical characteristics of cells, used in diagnosing blood cancers and immune disorders.

The accurate diagnosis of diseases relies on a combination of these clinical, radiological, laboratory, and specialized diagnostic methods. Each method provides unique and valuable information that, when integrated, leads to a comprehensive understanding of a patient's health and the appropriate management of their condition.

Treatment of Diseases:

The treatment of diseases involves various approaches, each selected based on the type of disease, its severity, and individual patient factors.

Let us summarize the primary treatment approaches used, along with detailed information about each and the rationale behind their use.

Medical (Pharmacological) Treatments

1.      Medications:

·         Antibiotics: Used to treat bacterial infections by killing bacteria or inhibiting their growth (e.g., penicillin for strep throat).

·         Antivirals: Treat viral infections by inhibiting the development of the virus (e.g., oseltamivir for influenza).

·         Antifungals: Treat fungal infections by killing or stopping the growth of fungi (e.g., fluconazole for candidiasis).

·         Analgesics: Relieve pain (e.g., acetaminophen for headaches, opioids for severe pain).

·         Anti-inflammatory Drugs: Reduce inflammation and pain (e.g., ibuprofen for arthritis).

·         Chemotherapy: Uses cytotoxic drugs to kill or stop the growth of cancer cells.

·         Immunosuppressants: Reduce immune system activity to prevent organ rejection or treat autoimmune diseases (e.g., cyclosporine).

2.      Surgical Treatments: 

Curative Surgery:

1.      Tumour Resection: Removal of cancerous tumours to eliminate the disease.

2.      Appendectomy: Removal of the appendix to treat appendicitis.

Reconstructive Surgery:

1.      Joint Replacement: Replacing damaged joints to restore function (e.g., hip replacement for osteoarthritis).

2.      Plastic Surgery: Reconstruction of body parts after trauma or disease (e.g., breast reconstruction after mastectomy).

Minimally Invasive Surgery:

1.      Laparoscopy: Small incisions and specialized tools for procedures like gallbladder removal, reducing recovery time.

2.      Endoscopy: Internal examination and treatment using an endoscope, often used for gastrointestinal issues.

Radiation Therapy

1. External Beam Radiation: Directs high-energy beams at tumours to kill cancer cells.
2. Internal Radiation (Brachytherapy): Places radioactive material inside or near the tumour, allowing high doses of radiation to target cancer cells with minimal damage to surrounding tissue.

Physical and Rehabilitation Therapies

1. Physical Therapy:

·         Exercise Programs: Strengthening and flexibility exercises to improve movement and function, often used for musculoskeletal injuries.

·         Manual Therapy: Hands-on techniques to manipulate muscles and joints, helping to relieve pain and improve mobility.

2. Occupational Therapy

Adaptive Techniques: Training to perform daily activities independently despite physical limitations (e.g., using assistive devices for eating or dressing).

3. Speech Therapy

Communication Skills: Helping patients with speech impairments to improve their speaking abilities (e.g., after a stroke).

Psychotherapy and Counselling

1. Cognitive Behavioural Therapy (CBT)

Behaviour Modification: Helps patients identify and change negative thought patterns and behaviours, effective in treating depression and anxiety.

2. Supportive Counselling

Emotional Support: Provides a safe space to discuss feelings and challenges, helping to manage mental health conditions.

Lifestyle and Behavioural Interventions

1. Dietary Changes

Nutritional counselling: Guides patients on healthy eating to manage conditions like diabetes, heart disease, and obesity.

2. Exercise Programs

Regular Physical Activity: Helps improve overall health, manage weight, and reduce the risk of chronic diseases.

3. Smoking Cessation

Behavioural Support and Medications: Aids in quitting smoking, significantly reducing the risk of respiratory and cardiovascular diseases.

Alternative and Complementary Therapies

1. Acupuncture

Pain Relief: Involves inserting thin needles into specific points on the body to relieve pain and improve overall well-being.

2. Herbal Medicine

Natural Remedies: Uses plant-based substances for therapeutic purposes, often integrated with conventional treatments.

Advanced and Experimental Treatments

1. Gene Therapy

Genetic Correction: Involves inserting, altering, or removing genes within a patient’s cells to treat genetic disorders (e.g., using CRISPR for genetic diseases).

2. Stem Cell Therapy

Regenerative Medicine: Uses stem cells to repair or replace damaged tissues and organs, with potential applications in treating conditions like Parkinson's disease and spinal cord injuries.

3. Immunotherapy

These various approaches are used to tailor treatment plans based on the specific needs of the patient and the nature of the disease. The goal is to provide effective,

The outcomes of clinical examinations, investigations, and treatments vary depending on several factors, including the type of disease, the specific method used, and individual patient characteristics. Below is an overview of the typical outcomes, accuracy, specificity, and success rates associated with these approaches.

Having described the above, you may like to ask what about the outcomes of all these clinical examinations and investigations?

I shall try to briefly answer from my experience as a clinician and a former senior medical researcher.

1. Clinical Examinations

Accuracy and Specificity: Physical examinations are crucial for initial assessments and can provide immediate insights into a patient's condition. However, their accuracy and specificity can be limited by the examiner's expertise and the subtlety of the symptoms.

Outcomes: Clinical examinations often guide the need for further testing. They are effective in diagnosing obvious conditions like fractures, infections, and acute illnesses.

2. Radiological Investigations

X-rays: Highly specific for detecting fractures, lung infections, and certain tumours. However, they have limitations in detecting soft tissue abnormalities.

CT scans: Provide detailed images and are highly accurate for detecting internal injuries, tumours, and infections. They are widely used due to their high diagnostic value.

MRI: Offers excellent specificity and accuracy for soft tissue evaluation, including brain, spinal cord, and joint assessments. It is invaluable for detailed imaging without radiation exposure.

Ultrasound: Non-invasive and accurate for visualizing organs and blood flow. It is particularly effective in obstetrics, cardiology, and abdominal assessments.

Nuclear Medicine: Highly specific for detecting functional changes in tissues, such as cancerous growths or bone metabolism abnormalities.

3. Laboratory Investigations

Blood Tests: Generally accurate and specific for detecting a wide range of conditions, from infections to metabolic disorders and organ function.

Urine Tests: Effective for diagnosing urinary tract infections, kidney diseases, and metabolic conditions.

Microbiological Tests: Cultures and sensitivity testing are very specific and accurate for identifying pathogens and determining appropriate treatments.

Genetic Testing: High specificity for identifying genetic disorders and predispositions, although some tests may have limitations in predictive value.

Outcomes of Treatments

1. Medical (Pharmacological) Treatments

·         Antibiotics/Antivirals/Antifungals: Generally, highly effective when used appropriately. Resistance can be an issue, reducing effectiveness.

·         Analgesics and Anti-inflammatory Drugs: Effective for pain and inflammation management. Success depends on the underlying condition and proper use.

·         Chemotherapy: Can be highly effective in treating cancers, though it often comes with significant side effects. Success rates vary based on cancer type and stage.

·         Immunosuppressants: Effective in preventing organ rejection and treating autoimmune diseases, though they increase infection risk.

2. Surgical Treatments

·         Curative Surgery: Often highly successful for localized conditions like appendicitis or certain cancers. Success depends on disease stage and surgical precision.

·         Reconstructive Surgery: Generally effective in restoring function and appearance, though outcomes can vary based on the complexity of the surgery and healing processes.

·         Minimally Invasive Surgery: Typically associated with faster recovery times and lower complication rates compared to open surgery.

3. Radiation Therapy

External Beam and Internal Radiation: Highly effective for many types of cancer. Success rates depend on cancer type, stage, and precision of radiation delivery.

4. Physical and Rehabilitation Therapies

·         Physical Therapy: Generally successful in improving mobility, reducing pain, and enhancing recovery from injuries and surgeries.

·         Occupational and Speech Therapy: Effective in helping patients regain independence and communication skills after injury or illness.

5. Psychotherapy and counselling

CBT and Supportive counselling: Proven effective for treating mental health conditions like depression and anxiety. Success rates vary based on patient engagement and the severity of the condition.

6. Lifestyle and Behavioural Interventions

·         Dietary Changes and Exercise Programs: Highly effective in managing chronic conditions like diabetes, heart disease, and obesity when adhered to.

·         Smoking Cessation: Significantly reduces the risk of respiratory and cardiovascular diseases, with success rates improved by combined behavioural and pharmacological support.

7. Alternative and Complementary Therapies

Acupuncture and Herbal Medicine: Can be effective for certain conditions like chronic pain and anxiety. Outcomes can vary widely based on practitioner expertise and individual responses.

8. Advanced and Experimental Treatments

Gene Therapy and Stem Cell Therapy: Show promise in treating genetic and degenerative conditions. While still largely experimental, they have demonstrated significant success in clinical trials.

Immunotherapy: Effective for various cancers and some autoimmune diseases, often providing new options in conventional treatments. The accuracy, specificity, and success of these examinations, investigations, and treatments generally provide positive outcomes, but they can vary based on the disease, the method used, and patient factors. The combination of advanced diagnostic tools and personalized treatment plans has greatly improved the ability to diagnose and effectively treat a wide range of diseases, leading to better patient outcomes and quality of

Diseases can be classified in various ways depending on different criteria such as aetiology, pathophysiology, affected systems, and duration. Here is a comprehensive classification of diseases:

1. By Aetiology (Cause)

·         Infectious Diseases: Caused by pathogens such as bacteria, viruses, fungi, or parasites. Examples include tuberculosis, influenza, and malaria.

·         Non-Infectious Diseases: Not caused by pathogens.

·         Genetic Diseases: Result from abnormalities in an individual's genetic makeup. Examples include cystic fibrosis and Down syndrome.

·         Nutritional Diseases: Caused by dietary deficiencies or excesses. Examples include scurvy (vitamin C deficiency) and obesity.

·         Environmental Diseases: Result from exposure to harmful substances or environmental factors. Examples include asbestosis and lead poisoning.

·         Occupational Diseases: Related to specific types of work. Examples include silicosis (from inhaling silica dust) and carpal tunnel syndrome.

·         Idiopathic Diseases: Diseases with no identifiable cause. Examples include idiopathic pulmonary fibrosis and idiopathic thrombocytopenic purpura.

2. By Pathophysiology (Mechanism)

·         Inflammatory Diseases: Characterized by inflammation. Examples include rheumatoid arthritis and inflammatory bowel disease.

·         Neoplastic Diseases: Involve abnormal cell growth, leading to benign or malignant tumours. Examples include breast cancer and melanoma.

·         Degenerative Diseases: Characterized by the progressive degeneration of tissues. Examples include Alzheimer's disease and osteoarthritis.

·         Metabolic Diseases: Affect metabolic processes. Examples include diabetes mellitus and hyperthyroidism.

·         Autoimmune Diseases: The immune system attacks the body's own tissues. Examples include lupus and multiple sclerosis.

·         Genetic and Congenital Diseases: Present at birth due to genetic mutations or developmental issues. Examples include congenital heart defects and haemophilia.

3. By Body System

·         Cardiovascular Diseases: Affect the heart and blood vessels. Examples include coronary artery disease and hypertension.

·         Respiratory Diseases: Affect the lungs and respiratory tract. Examples include asthma and chronic obstructive pulmonary disease (COPD).

·         Gastrointestinal Diseases: Affect the digestive tract. Examples include Crohn's disease and peptic ulcers.

·         Neurological Diseases: Affect the brain and nervous system. Examples include epilepsy and Parkinson's disease.

·         Endocrine Diseases: Affect hormone-producing glands. Examples include diabetes and thyroid disorders.

·         Musculoskeletal Diseases: Affect muscles, bones, and joints. Examples include osteoporosis and rheumatoid arthritis.

·         Renal and Urinary Diseases: Affect the kidneys and urinary system. Examples include chronic kidney disease and urinary tract infections.

·         Hematologic Diseases: Affect the blood and blood-forming organs. Examples include anaemia and leukaemia.

·         Dermatologic Diseases: Affect the skin. Examples include eczema and psoriasis.

4. By Duration and Course

• Acute Diseases: Have a sudden onset and a short course. Examples include the common cold and acute appendicitis.
• Chronic Diseases: Persist for a long time, often for the patient's lifetime. Examples include chronic obstructive pulmonary disease (COPD) and diabetes.
• Subacute Diseases: Have characteristics that are between acute and chronic. Examples include subacute bacterial endocarditis.
• Recurrent Diseases: Characterized by periods of remission and relapse. Examples include multiple sclerosis and herpes simplex infections.

5. By Severity

·         Mild Diseases: Cause minor discomfort and often resolve without treatment. Examples include the common cold and mild allergies.

·         Moderate Diseases: Cause significant discomfort or impairment but are usually manageable with treatment. Examples include moderate asthma and controlled hypertension.

·         Severe Diseases: Cause significant disability or are life-threatening. Examples include severe sepsis and advanced cancer.

6. By Mode of Transmission (for Infectious Diseases)

·         Communicable Diseases: Spread from person to person or from animals to people. Examples include influenza and HIV/AIDS.

·         Non-Communicable Diseases: Not spread from person to person. Examples include most genetic and chronic diseases like diabetes and heart disease.

7. By Response to Treatment

·         Curable Diseases: Can be completely eradicated with treatment. Examples include bacterial infections treated with antibiotics and some cancers caught early.

·         Incurable Diseases: Cannot be completely cured, though treatment may manage symptoms and improve quality of life. Examples include Alzheimer's disease and certain chronic conditions like rheumatoid arthritis.

8. By Epidemiological Characteristics

·         Endemic Diseases: Regularly found in a certain area or population. Examples include malaria in certain tropical regions.

·         Epidemic Diseases: Occur in excess of what is normally expected in a community or region. Examples include the Ebola outbreak in West Africa.

·         Pandemic Diseases: An epidemic that has spread over several countries or continents, usually affecting many people. Examples include COVID-19 and the 1918 influenza pandemic.

These classifications help healthcare professionals understand, diagnose, and treat diseases more effectively by considering various aspects such as cause, affected systems, severity, and response to treatment. Each classification provides valuable insights that guide clinical decision-making and public health strategies.

I have given a very brief outline, yet comprehensive description of most of the areas we do in medicine for the diagnosis and treatment of diseases for lay readers to understand for their general education.

Unfortunately, not many doctors know these. Most doctors are unaware of all of them that are available, including specialists who are confined to their own areas of medicine, and they may not use many of these diagnostic areas, except the usual common ones, like history talking, looking for signs and symptoms, auscultation, percussion, and palpation, besides X-rays and other radiological imaging where all doctors ought to know.  

Hope this helps. Remember what I wrote here:

The Origin and Purpose of the Soul. 

https://scientificlogic.blogspot.com/2024/

Finally, it is the soul that controls all the chemistries and the health in your body, not the doctor, anyone, or anything else.  

So, take care. 

Lim jb