Salt imbalance occurs in nearly a third of hospitalized patients!

Simple guidelines for diagnosing and treating a salt imbalance occurring in up to 30% of hospitalized patients are published in the European Journal of Endocrinology. The guidelines recommend that any hospital-based clinician must be able to correctly diagnose, classify and treat hypernatremia, which is associated with morbidity, mortality and length of hospital stay in a wide range of conditions.

Hypernatremia is a complicated disorder of water balance, with a relative excess of body water compared to sodium and potassium (defined as a serum sodium concentration <135mmol/l). It has a wide variety of underlying causes, and results in swelling (known as cellular edema). Cells of the brain are particularly vulnerable to damage by swelling, making severe cases medical emergencies. Milder cases can be associated with impaired mobility and cognition, as well as osteoporosis and fracture.

The guidelines describe a pathway for diagnosis which is less reliant on specialist laboratory resources, and can be conducted in the general hospital setting. The treatment pathway described in the document focuses more closely on the patients' symptoms, giving lower priority to biochemical diagnosis. The guidelines recommend that as the risks to the patient's brain are so great, in severe cases action is more important than investigation until the patient is stabilized.

The full guidelines can be downloaded for free from the European Journal of Endocrinology, the official journal of the European Society of Endocrinology.

Heart Rate- Why is it Important?

The heart rate is one of our vital signs - it is the number of times a minute that our heart contracts or beats. The rate of heart contractions is equal to the pulse, which is how many times a minute that our arteries expand because of the increase in blood pressure originated by our heartbeat. Resting pulse should be measured first thing in the morning with your fingers and a stopwatch. Put your middle and index finger to either your radial artery on your wrist or your carotid artery in your neck. Once you find your pulse, count how many beats occur in 20 seconds, and multiply this number by 3. This is your resting pulse.

Resting pulse varies from person to person. The average resting pulse should be between 60-80 beats per minute (BPM). 68-80 BPM is by no means the only place a healthy person’s pulse can be. A variety of factors can affect your resting pulse reading, including the physical size of your heart, body size, activity level, fitness level, temperature, body position, emotions and medication use.

The more you work out the lower your resting pulse is, and the lower your resting pulse is the less hard your heart has to work. The best way to think about is to view your heart as a muscle, and the more you work it the stronger it gets. A stronger heart means more blood with each beat, and the same amount of work can be done with fewer beats. If your heart needs more beats to do the same amount of work, over time this can lead to cardiovascular diseases.

A higher resting pulse than usual can be a sign of over-training or illness. When you are recovering from a workout, your metabolism and heart are working harder to repair your body and get it back to a homeostasis. Therefore, if in the morning you have a higher resting heart rate than usual, your body could still be in a state of repair and you should adjust your workout regimen accordingly to prevent over-training or injury.

Selenium and vitamin E supplements increase prostate cancer risk!

A new study recently published in the Journal of the National Cancer Institute suggests that taking high doses of selenium and vitamin E supplements may increase the risk of prostate cancer, depending on a man's selenium levels prior to taking the supplements.

According to the investigators, previous research has suggested that men who already have an adequate intake of selenium would not benefit from supplements of the nutrient.

Selenium is a chemical element most commonly found in seafood and organ meats, such as liver. Other food sources of selenium include muscle meats, cereals and dairy products. The National Institutes of Health state that selenium is nutritionally essential for humans and plays roles in reproduction, thyroid hormone metabolism and DNA syntheses, as well as protects against oxidative damage and infection. According to the Food and Nutrition Board, the recommended dietary allowance for both males and females aged 14 years and over is 55 mcg per day.

Vitamin E is a group of fat-soluble compounds that act as an antioxidant in the body. The vitamin is commonly found in foods such as nuts, seeds, vegetable oils, green leafy vegetables and fortified cereals.

For the study, the researchers wanted to determine whether taking daily high doses of vitamin E (400 IU) and/or selenium (200 mcg) may reduce the risk of prostate cancer. The findings revealed that men who had high selenium levels at the beginning of the study had a 91% increased risk of high-grade prostate cancer. According to the researchers, the levels of selenium for these men became toxic.

The investigators also found that for men with low selenium levels at the baseline of the study, vitamin E increased total prostate cancer risk by 63%, while high-grade prostate cancer risk increased by 111%. Many people think that dietary supplements are helpful or at the least innocuous. This is not true. Researchers add that people taking vitamin E or selenium supplements should stop because there is no evidence that they produce any health benefits - only risks.

Taking a broad view of the recent scientific studies, there is an emerging consistency about how we think about optimal intake of micronutrients. There are optimal levels, and these are often the levels obtained from a healthful diet, but either below or above the levels there are risks.

No more biopsies in lung diseases

Idiopathic pulmonary fibrosis (IPF) is an inflammatory lung disorder of unknown origin characterized by abnormal formation of fibrous tissue between the tiny air sacs or ducts of the lungs. This is an extremely fatal disease, usually occurs in adult individuals of between 50 and 70 years of age, particularly those with a history of cigarette smoking, and affects more men than women.

People who are suspected to have the lung disease idiopathic pulmonary fibrosis may not have to undergo biopsies, as clinical and radiological results should provide a confident diagnosis, according to a new study published in The Lancet Respiratory Medicine journal. There is no cure for this and most people will only survive for 3 to 5 years following diagnosis. The disease causes scarring of the lungs, which worsens over time, until the lungs are unable to supply the required levels of oxygen to the rest of the body.

High resolution computed tomography is used to identify IPF, as the disease often leaves a characteristic "honeycomb" scarring pattern, known as usual interstitial pneumonia. Currently, when IPF is suspected in a patient but there is no sign of the UIP pattern; international guidelines recommend that a biopsy be taken to confirm the diagnosis.

But taking a biopsy from the lung is a risky procedure. Surgical lung biopsy is associated with substantial risks and many patients are too elderly, sick, and/or have co morbid conditions to tolerate the invasive procedure. A confident diagnosis of IPF is needed to ensure that patients are well informed of the poor prognosis associated with IPF, are treated with the most appropriate therapies, consider participation in clinical trials of new therapies, and to identify those most suitable for lung transplantation.

The researchers wanted to see if IPF could be accurately diagnosed in patients who do not exhibit UIP from HRCT scans, without the need for a biopsy. To test this, the team showed expert radiologists and pathologists HRCT scans of 315 patients who had previously been suspected of IPF - but who presented with little or no visible honeycombing. The experts were able to diagnose with 94% accuracy the patients who had IPF but whose scans exhibited little or no scarring. The researchers knew that the experts' diagnoses were accurate, as they also had access to results of the patients' biopsies.

These findings suggest that when a team of multidisciplinary experts in interstitial lung disease at a regional center (that includes a chest radiologist and a pulmonologist) work together to interpret possible UIP pattern on high-resolution CT in a patient suspected to have IPF, surgical lung biopsy might not be necessary to reach a diagnosis of IPF. However, because of the retrospective nature of the study and the way that cases were selected - results in day-to-day clinical settings may not be the same. But experts predict that the role of lung biopsy will diminish, with lung disease diagnoses more likely to come from non-invasive techniques such as multidisciplinary meetings in conjunction with HRCT.

Ginkgo biloba promotes better blood flow and a healthy brain

Ginkgo biloba, also known as the maidenhair tree, is one of the oldest species of trees on the planet. The tree is considered to be a "living fossil", meaning that it has continued to survive even after major extinction events. 

Over a long period of time, ginkgo biloba has developed a well deserved reputation for its main health benefits associated with improved blood circulation in the body and especially in the brain. Many health practitioners have recognized the medicinal herbs outstanding results when it comes to improving memory and overall brain functions.

The ginkgo leaves contain chemicals (flavonoids and terpenoids) that act as important antioxidants inhibiting the damage free radicals can cause from expanding within your body and cells, something that's even more important as you age. By fighting off these particles, ginkgo biloba's effects help prevent debilitating health conditions such as heart disease, cancer and Alzheimer's disease.

This herb's principal quality is its ability to increase and improve blood flow by dilating blood vessels, therefore it’s no surprise that various laboratory tests and animal studies showed that its flavonoids protect the nerves, heart muscle, blood vessels and retina from damage.

Studies about Alzheimer's disease and general dementia have shown mixed results so far when compared with placebos, although more research needs to be done in order to validate ginkgo biloba's true worth with such health problems. Up to now, it's more important to note that it does improve thinking, learning and overall cognitive functions; plus it improves social behavior while also reducing feelings of depression.

Sunlight helps in reducing blood pressure!

New research conducted by the Universities of Southampton and Edinburgh in the UK, suggests that exposure to sunlight may help reduce blood pressure. In turn, this could cut the risk of heart attack and stroke.

Over time, high blood pressure can lead to serious problems including heart disease, stroke and kidney failure. Heart disease globally accounts for 30% of deaths every year. In some people, high blood pressure can also cause aneurysms, narrowing of the arteries or vision impairment. We already know that following a healthy diet (without eating too much salt or drinking too much alcohol), being physically active, staying at a healthy weight, not smoking and learning to manage stress all help maintain normal blood pressure.

This new study found that exposure of the skin to sunlight may also reduce blood pressure, by reducing levels of small messenger molecules and nitric oxide in the skin and blood.

Nitric oxide along with its breakdown products, known to be abundant in skin, is involved in the regulation of blood pressure. When exposed to sunlight, small amounts of NO are transferred from the skin to the circulation, lowering blood vessel tone; as blood pressure drops, so does the risk of heart attack and stroke. But further research needs to be done before the researchers can conclude that sunlight is effective at lowering blood pressure in more chronic settings.

Individuals who have high blood pressure can prevent future complications by eating healthily, exercising regularly, avoiding the temptations of nicotine, alcohol and too much salt, and doing their best to lead a stress-free life.

Automated external defibrillation

Heart disease is the number one killer all over the world. Current projections suggest that India will have the largest cardiovascular disease burden in the world. A heart attack occurs when the heart is starved of oxygen. A heart attack can ‘stun’ the heart and interrupt its rhythm and ability to pump.

Most of these deaths occur with little or no warning, from a syndrome called sudden cardiac arrest. The most common cause of sudden cardiac arrest is a disturbance in the heart rhythm called ventricular fibrillation. Ventricular fibrillation is dangerous because it cuts off blood supply to the brain and other vital organs. The ventricles are the chambers that pump blood out of the heart and into the blood vessels. This blood supplies oxygen and nutrients to organs, cells, and other structures. If these structures do not receive enough blood, they start to shut down, or fail. If blood flow is not restored immediately, permanent brain damage or death is the result.

Ventricular fibrillation often can be treated successfully by applying an electric shock to the chest with a procedure called defibrillation. In coronary care units, most people who experience ventricular fibrillation survive, because defibrillation is performed almost immediately.

The situation is just the opposite when cardiac arrest occurs outside a hospital setting. Unless defibrillation can be performed within the first few minutes after the onset of ventricular fibrillation, the chances for reviving the person (resuscitation) are very poor. For every minute that lapses with a person remaining in ventricular fibrillation, and defibrillation is not provided, the chances of resuscitation drop by almost 10 percent. After 10 minutes, the chances of resuscitating a victim of cardiac arrest are near zero.

Cardiopulmonary resuscitation, usually known as CPR, provides temporary artificial breathing and circulation. It can deliver a limited amount of blood and oxygen to the brain until a defibrillator becomes available. However, defibrillation is the only effective way to resuscitate a victim of ventricular fibrillation.

Understanding CRP Blood Test

A C-reactive protein (CRP) test is a blood test that measures the amount of a protein called C-reactive protein in your blood. C-reactive protein measures general levels of inflammation in your body. High levels of CRP are caused by infections and many long-term diseases. But a CRP test cannot show where the inflammation is located or what is causing it. Other tests are needed to find the cause and location of the inflammation.

A C-reactive protein (CRP) test is done to check for infection after surgery. CRP levels normally rise within 2 to 6 hours of surgery and then go down by the third day after surgery. If CRP levels stay elevated 3 days after surgery, an infection may be present. CRP test is also done to identify and keep track of infections and diseases that cause inflammation, such as cancer of the lymph nodes (lymphoma), diseases of the immune system, such as lupus, painful swelling of the blood vessels in the head and neck (giant cell arteritis), painful swelling of the tissues that line the joints (rheumatoid arthritis), swelling and bleeding of the intestines (inflammatory bowel disease), infection of a bone (osteomyelitis) etc.

A special type of CRP test, the high-sensitivity CRP test (hs-CRP), may be done to find out if you have an increased chance of having a sudden heart problem, such as a heart attack. Inflammation can damage the inner lining of the arteries and make having a heart attack more likely. But the connection between high CRP levels and heart attack risk is not very well-understood.

Can yearly blood tests reveal early-stage ovarian cancer?

The term "ovarian cancer" includes several different types of cancer that all arise from cells of the ovary. Most commonly, tumors arise from the epithelium, or lining cells, of the ovary. These include epithelial ovarian (from the cells on the surface of the ovary), fallopian tube, and primary peritoneal (the lining inside the abdomen that coats many abdominal structures) cancer. These are all considered to be one disease process. There is also an entity called borderline ovarian tumors that have the microscopic appearance of a cancer, but tend not to spread much.

Ovarian cancer accounts for about four per cent of all cancers in women. However it is a highly aggressive cancer and is one of the leading causes of death. Unfortunately early-stage ovarian cancer usually causes either no symptoms or very non-specific ones such as abdominal bloating, loss of appetite, dyspepsia and sometimes even urinary complaints. Therefore almost three fourths of women are diagnosed in the third or fourth stages. In these patients many effective treatment options are available including surgery, chemotherapy and targeted therapy. However, only a minority of these patients will be cured of their disease. The cure rate for early stage ovarian cancer is close to 90 per cent whereas it is less than 20 per cent for advanced stage patients.

Indian women are among the last ones to visit the doctor when it comes to their own health. This coupled with lack of awareness has been the major driver for ovarian cancer cases to increase. Because this condition usually occurs during menopause, most women ignore the symptoms, and further delay the treatment process.

A new way of screening for ovarian cancer appears to detect the disease in early stages, and if confirmed in clinical trials, the test could become a routine screening for women. In a recent study, researchers tested the screening on more than 4,000 women over an 11-year period. The women underwent yearly blood tests, and the researchers recorded the levels of a protein called CA-125, which is produced by the majority of ovarian tumors. Women who had sudden increases in CA-125 levels were referred to a gynecologist and were given an ultrasound.

On the basis of their ultrasound results, 10 women underwent surgery during the study period. It turned out that four women had ovarian cancers still in an early stage, and five others had ovarian tumors that were either benign, or of low malignant potential (tumors that may become cancerous, but usually do not). One woman had endometrial cancer, according to the study published today in the journal Cancer.  The study suggested that the testing strategy had a specificity of 99.9 percent, the researchers said, meaning that only 0.1 percent of patients without cancer would be falsely identified as having the disease.

The researchers are waiting for the results of a larger, randomized study currently being conducted in the United Kingdom that uses the same screening strategy. The results are scheduled to be released by 2015. 

Skin with blood and lymphatic capillaries grown

Conventional skin grafting involves healthy skin being removed from one area of the body to replace damaged skin. Only small areas of skin can be removed from the patient because it creates a new wound. Skin can also be engineered for grafting, which involves taking a patient's cells and growing skin from them. This is then used to replace damaged skin. So far, engineered skin has not contained blood or lymphatic capillaries, sebaceous glands, pigmentation, hair follicles or nerves.

But the research team, from the University of Zurich and the University Children's Hospital Zurich, has discovered a way to create skin that contains fully functional blood and lymphatic capillaries.

Lymphatic capillaries are small vessels located in the spaces between all cells in the body, except the tissues of the central nervous system and non-vascular tissue. The main function of the lymphatic capillaries is to drain excess fluid that has been excreted from tissues following a wound. This helps the wound healing process. Blood capillaries are the smallest of all blood vessels in the body that connect the veins and the arteries.

For the study, the researchers isolated blood and lymphatic capillary cells from samples of human skin. Using these cells, they were able to engineer a skin graft similar to full-thickness skin that contains fully functioning blood and lymphatic capillaries. The research team found that the lymphatic capillary cells instinctively arranged themselves into lymphatic capillaries and had the same characteristics as lymphatic vessels. When the investigators put this engineered skin to the test in preclinical trials, they found that both the blood and lymphatic capillaries were able to connect with those of laboratory animals.

What's novel in this is that the lymphatic capillaries collected and transported tissue fluid; hence they were functional. It can be assumed that skin grafts with lymphatic and blood capillaries will, in future, both prevent the accumulation of tissue fluid and ensure rapid blood supply of the graft. The investigators say the first clinical application of these skin grafts is already planned to take place this year. But they note that approval still has to be achieved for testing with blood and lymphatic capillaries, and therefore the skin grafts will go ahead without them.

Lab tests used in cancer diagnosis

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems and they can release hormones that alter body function.

If it's suspected that a patient has cancer, doctor may order certain cancer blood tests or other laboratory tests, such as an analysis of your urine or a biopsy of a suspicious area, to help guide the diagnosis. With the exception of blood cancers, blood tests generally can't absolutely tell whether a patient has cancer or some other noncancerous condition, but they can give doctor clues about what's going on inside the patient’s body.

Examples of blood and urine tests used to diagnose cancer include:

Complete blood count (CBC): This common blood test measures the amount of various types of blood cells in a sample of blood. Blood cancers may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found. A bone marrow biopsy may help confirm a diagnosis of a blood cancer.

Urine cytology: Examining a urine sample under a microscope may reveal cancer cells that could come from the bladder, ureters or kidneys.

Blood protein testing: A test to examine various proteins in your blood (electrophoresis) can aid in detecting certain abnormal immune system proteins (immunoglobulins) that are sometimes elevated in people with multiple myeloma. Other tests, such as a bone marrow biopsy, are used to confirm a suspected diagnosis.

Tumor marker tests: Tumor markers are chemicals made by tumor cells that can be detected in your blood. But tumor markers are also produced by some normal cells in your body and levels may be significantly elevated in noncancerous conditions. This limits the potential for tumor marker tests to help in diagnosing cancer.

The best way to use tumor markers in diagnosing cancer hasn't been determined. And the use of some tumor marker tests is controversial also. Examples of tumor markers include prostate-specific antigen for prostate cancer, cancer antigen 125 for ovarian cancer, calcitonin for medullary thyroid cancer, alpha-fetoprotein for liver cancer and human chorionic gonadotropin for germ cell tumors, such as testicular cancer and ovarian cancer.