Thursday 31 October 2013

Arsenic Poisoning Part-3

Arsenic Poisoning Part-3


What is organic arsenic?

Organic arsenic is any compound that is made from a chemical combination of the element arsenic with any organic compound (compounds containing a large amount of carbon). These are often termed arsenical organic compounds. Most frequently organic arsenic is a component used in making insecticides and weed killers and other compounds. Organic arsenic usually is not poisonous to humans but may be poisonous to humans in high concentrations. In general, organic arsenic is usually far less poisonous than inorganic arsenic.

What are the symptoms of arsenic poisoning?


People can be exposed to arsenic by inhaling it, by consuming contaminated foods, water, or beverages, or by skin contact. We are normally exposed to trace amounts of arsenic in the air and water, and in foods. People may be exposed to higher levels if they live near industrial areas that currently or formerly contained arsenic compounds. Areas with known high concentrations of arsenic in the drinking water are also associated with greater exposure.
Acute or immediate symptoms of a toxic level of exposure to arsenic may include the following:
  • Vomiting
  • Abdominal pain
  • Diarrhea
  • Dark urine (termed black water urine)
  • Dehydration
  • Cardiac problems
  • Hemolysis (destruction of red blood cells)
  • Vertigo
  • Delirium
  • Shock
  • Death
Long-term exposures to aresenic lower than toxic levels can lead to skin changes (darkening or discoloration, redness, swelling and hyperkeratosis (skin bumps that resemble corns or warts). Whitish lines (Mees' lines) may appear in the fingernails. Both sensory and motor nerve defects can develop. Additionally, liver and kidney function may be affected.

Arsenic exposure over the long-term has also been associated with the development of certain cancers, and arsenic has been classified as a carcinogen by the Environmental Protection Agency (EPA). Studies of people in parts of Southeast Asia and South America where there has been a high level of arsenic in the drinking water have reported an increased risk of developing cancers of the bladder, kidney, lung, and skin. Organic arsenic compounds are not as toxic as inorganic compounds and are not believed to be linked to cancer.

Tuesday 29 October 2013

Arsenic Poisoning Part-2



Arsenic Poisoning Part-2

Arsenic is a grey-appearing chemical element (atomic number 33, symbol As in the periodic table) also termed a metalloid. Arsenic can exist in a metallic state in three forms (yellow, black, and gray; with gray predominating) and in ionic forms. Arsenic is considered to be a heavy metal, and arsenic toxicity shares some features with poisonings by other heavy metals. Historically, arsenic has been used as a medicinal agent, a pigment, a pesticide, and an agent with intent to harm (use with criminal intent). Up until 2003, arsenic (in the form of chromated copper arsenate) was used in the US as a treatment to prevent insect infestation of wood used in building. In 2003 the use of this compound was banned by the US Environmental Protection Agency.
Arsenic is mixed with copper or lead to strengthen alloys containing these materials. Arsenic and some of its compounds react with proteins, mainly the thiol portions, and uncouples the process of oxidative phosphorylation, thus inactivating most cellular functions. Consequently, arsenic and some of the substances it combines with are deadly poisons to most biologic systems, except for a few bacterial species. Arsenic is used in making insecticides and weed killers. Arsenic is also thought to be carcinogenic, meaning that it has the potential to cause cancer.
Arsenic can be found as a contaminant in food and water sources. Shellfish and other seafood, as well as fruits, vegetables, and rice; are the foods most commonly contaminated. Arsenic poisoning typically occurs as a result of industrial exposure, from contaminated wine or illegally distilled spirits, or in cases of malicious intent.

What is inorganic arsenic?


Inorganic arsenic is metallic or metalloid element that forms a number of poisonous compounds. In industry, it can be found in a gaseous form termed arsine gas that is very toxic when inhaled. Inorganic arsenic is found in nature at low levels mostly compounded with oxygen, chlorine, and sulfur. These are called inorganic arsenic compounds. Inorganic arsenic compounds are much more poisonous to most biologic systems (animals, plants, humans) than organic arsenic (see below). Inorganic arsenic occurs in nature in the soil, copper and lead ore deposits, and water, but usually in low concentrations. However, it can become more concentrated when industrial processes use it to make wood preservatives, metal compounds, or organic arsenic-containing compounds such as insecticides, weed killers, and other compounds. If such compounds are burned, inorganic arsenic can be released into the air and later settle on the ground or in water and either remain in the inorganic form or combine with organic material.

Monday 28 October 2013

Arsenic Poisoning Part-1

Arsenic facts

  • Arsenic is an element (metalloid) that can combine with organic and inorganic substances.
  • Inorganic arsenic is arsenic alone or combined with inorganic substances that are very toxic to most biologic systems, including humans.
  • Organic arsenic is arsenic combined with organic substances and may be non-toxic or far less toxic to many biologic systems than inorganic arsenic.
  • Symptoms of arsenic poisoning vary with the type and concentration of the poison; inorganic arsenic may cause abdominal pains, destruction of red blood cells (hemolysis ), shock, and death quickly, while lower concentrations and occasionally organic arsenic cause far less severe symptoms.
  • Diagnosis of arsenic poisoning is made by determining inorganic and organic levels of arsenic in the blood and urine.
  • Treatment of arsenic poisoning in acute toxic poisonings needs to begin quickly; treatment involves removal of arsenic by dialysis, chelating agents, replacement of red blood cells, and if ingested, bowel cleansing.
  • Acute toxic inorganic arsenic poisoning has only a fair to poor outcome; chronic poisoning has a better outcome.
  • Arsenic is found in groundwater, many chemicals, and foods. If arsenic is in the organic form, it is likely nontoxic or weakly toxic to humans, but inorganic arsenic can also be found in similar locations and materials and in high concentrations in industrial processes. In 2013, the FDA made recommendations that less than 10 parts per billion of arsenic was acceptable for levels in apple juice. Levels for arsenic have yet to be FDA approved for rice (still under study), although groundwater levels that provide arsenic to rice are FDA set at less than 10 parts per billion.

Sunday 27 October 2013

Chemotherapy Part-6



Chemotherapy Part-6


What are clinical trials and are they an option for me?

Cancer clinical trials (also called cancer treatment studies or research studies) test new treatments for people with cancer. These can be studies of new types of chemotherapy, other types of treatment, or new ways to combine treatments. The goal of all these clinical trials is to find better ways to help people with cancer.
Your doctor or nurse may suggest you take part in a clinical trial. You can also suggest the idea. Before you agree to be in a clinical trial, learn about:
  • Benefits. All clinical trials offer quality cancer care. Ask how this clinical trial could help you or others. For instance, you may be one of the first people to get a new treatment or drug.
  • Risks. New treatments are not always better or even as good as standard treatments. And even if this new treatment is good, it may not work well for you.
  • Payment. Your insurance company may or may not pay for treatment that is part of a clinical trial. Before you agree to be in a trial, check with your insurance company to make sure it will pay for this treatment.

Tips for Meeting With Your Doctor or Nurse

  • Make a list of your questions before each appointment. Some people keep a "running list" and write down new questions as they think of them. Make sure to have space on this list to write down the answers from your doctor or nurse.
  • Bring a family member or trusted friend to your medical visits. This person can help you understand what the doctor or nurse says and talk with you about it after the visit is over.
  • Ask all your questions. There is no such thing as a stupid question. If you do not understand an answer, keep asking until you do.
  • Take notes. You can write them down or use a tape recorder. Later, you can review your notes and remember what was said.
  • Ask for printed information about your type of cancer and chemotherapy.
  • Let your doctor or nurse know how much information you want to know, when you want to learn it, and when you have learned enough. Some people want to learn everything they can about cancer and its treatment. Others only want a little information. The choice is yours.
  • Find out how to contact your doctor or nurse in an emergency. This includes who to call and where to go.

Chemotherapy Part-5



Chemotherapy Part-5


How will I know if my chemotherapy is working?

Your doctor will give you physical exams and medical tests (such as blood tests and x-rays). He or she will also ask you how you feel.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well. Or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

How much does chemotherapy cost?

It is hard to say how much chemotherapy will cost. It depends on:
  • The types and doses of chemotherapy used
  • How long and how often chemotherapy is given
  • Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
  • The part of the country where you live
Does my health insurance pay for chemotherapy?
Talk with your health insurance plan about what costs it will pay for. Questions to ask include:
  • What will my insurance pay for?
  • Do I or does the doctor's office need to call my insurance company before each treatment for it to be paid for?
  • What do I have to pay for?
  • Can I see any doctor I want or do I need to choose from a list of preferred providers?
  • Do I need a written referral to see a specialist?
  • Is there a co-pay (money I have to pay) each time I have an appointment?
  • Is there a deductible (certain amount I need to pay) before my insurance pays?
  • Where should I get my prescription drugs?
  • Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?
How can I best work with my insurance plan?
  • Read your insurance policy before treatment starts to find out what your plan will and will not pay for.
  • Keep records of all your treatment costs and insurance claims.
  • Send your insurance company all the paperwork it asks for. This may include receipts from doctors' visits, prescriptions, and lab work. Be sure to also keep copies for your own records.
  • As needed, ask for help with the insurance paperwork. You can ask a friend, family member, social worker, or local group such as a senior center.
  • If your insurance does not pay for something you think it should, find out why the plan refused to pay. Then talk with your doctor or nurse about what to do next. He or she may suggest ways to appeal the decision or other actions to take.

Saturday 26 October 2013

Chemotherapy Part-4



Chemotherapy Part-4


How will I feel during chemotherapy?

Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during chemotherapy.
Some people do not feel well right after chemotherapy. The most common side effect is fatigue, feeling exhausted and worn out. You can prepare for fatigue by:
  • Asking someone to drive you to and from chemotherapy
  • Planning time to rest on the day of and day after chemotherapy
  • Getting help with meals and childcare the day of and at least 1 day after chemotherapy
There are many ways you can help manage chemotherapy side effects.

Can I work during chemotherapy?

Many people can work during chemotherapy, as long as they match their schedule to how they feel. Whether or not you can work may depend on what kind of work you do. If your job allows, you may want to see if you can work part-time or work from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.


One way to let your doctor or nurse know about these drugs is by bringing in all your pill bottles. Your doctor or nurse needs to know:
  • The name of each drug
  • The reason you take it
  • How much you take
  • How often you take it
Talk to your doctor or nurse before you take any over-the-counter or prescription drugs, vitamins, minerals, dietary supplements, or herbs.
Can I take vitamins, minerals, dietary supplements, or herbs while I get chemotherapy?

ChemotherapyPart-3


 


Chemotherapy Part-3

How is chemotherapy given?

Chemotherapy may be given in many ways.
  • Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
  • Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.
  • Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).
  • Intravenous (IV). The chemotherapy goes directly into a vein.
  • Topically. The chemotherapy comes in a cream that you rub onto your skin.
  • Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.
Things to know about getting chemotherapy through an IV
Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy.
IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.
  • Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter.
  • Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port.
  • Pumps. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.

Friday 25 October 2013

Complete Blood Count-Part-2


 


 Complete Blood Count-Part-2

What are values for a complete blood count (CBC)?

The values generally included are the following:
  • White blood cell count (WBC) is the number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter (cmm). This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 to 10.8 x 109 cells per liter.
A machine generated percentage of the different types of white blood cells is called the automated WBC differential. These components can also be counted under the microscope on a glass slide by a trained laboratory technician or a doctor and referred to as the manual WBC differential.
  • Red cell count (RBC) signifies the number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 to 5.9 million cells/cmm. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 to 5.9 x 1012 cells per liter.
Red blood cells are the most common cell type in blood and people have millions of them in their blood circulation. They are smaller than white blood cells, but larger than platelets.
Picture of Red Blood Cells
  • Hemoglobin (Hb). This is the amount of hemoglobin in a volume of blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Normal range for hemoglobin is different between the sexes and is approximately 13 to 18 grams per deciliter for men and 12 to 16 for women (international units 8.1 to 11.2 millimoles/liter for men, 7.4 to 9.9 for women).
  • Hematocrit (Hct). This is the ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45% to 52% for men and 37% to 48% for women. This is usually measured by spinning down a sample of blood in a test tube, which causes the red blood cells to pack at the bottom of the tube.
  • Mean corpuscular volume (MCV) is the average volume of a red blood cell. This is a calculated value derived from the hematocrit and red cell count. Normal range may fall between 80 to 100 femtoliters (a fraction of one millionth of a liter).
  • Mean Corpuscular Hemoglobin (MCH) is the average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 to 32 picograms.
  • Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32% to 36%.
  • Red Cell Distribution Width (RDW) is a measurement of the variability of red cell size and shape. Higher numbers indicate greater variation in size. Normal range is 11 to 15.
  • Platelet count. The number of platelets in a specified volume of blood. Platelets are not complete cells, but actually fragments of cytoplasm (part of a cell without its nucleus or the body of a cell) from a cell found in the bone marrow called a megakaryocyte. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 to 400,000/ cmm (150 to 400 x 109/liter).
  • Mean Platelet Volume (MPV). The average size of platelets in a volume of blood.

Complete Blood Count (CBC) Part-1


 


Complete Blood Count (CBC)

What is the complete blood count test (CBC)?

The complete blood count (CBC) is one of the most commonly ordered blood tests. The complete blood count is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by special machines that analyze the different components of blood in less than a minute.
A major portion of the complete blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood.

How is the complete blood count test (CBC) done?

The complete blood count (CBC) test is performed by obtaining a few milliliters (one to two teaspoons) of blood sample directly form the patient. It can be done in many settings including the doctor's office,  laboratories, and hospitals. The skin is wiped clean with an alcohol pad, and then a needle is inserted through the area of cleansed skin into to patient's vein (one that can be visualized from the skin.) The blood is then pulled from the needle by a syringe or by a connection to a special vacuumed vial where it is collected. This sample is then taken to the laboratory for analysis.

Thursday 24 October 2013

Chemotherapy Part-2


 


 

Chemotherapy Part-2

How does my doctor decide which chemotherapy drugs to use?

This choice depends on:
  • The type of cancer you have. Some types of chemotherapy drugs are used for many types of cancer. Other drugs are used for just one or two types of cancer.
  • Whether you have had chemotherapy before
  • Whether you have other health problems, such as diabetes or heart disease

Where do I go for chemotherapy?

You may receive chemotherapy during a hospital stay, at home, or in a doctor's office, clinic, or outpatient unit in a hospital (which means you do not have to stay overnight). No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and make any needed drug changes.

How often will I receive chemotherapy?

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:
  • Your type of cancer and how advanced it is
  • The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)
  • The type of chemotherapy
  • How your body reacts to chemotherapy
You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.

Can I miss a dose of chemotherapy?

It is not good to skip a chemotherapy treatment. But sometimes your doctor or nurse may change your chemotherapy schedule. This can be due to side effects you are having. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

Chemotherapy Part-1


 


 Chemotherapy

What is chemotherapy?

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.

How does chemotherapy work?

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.

What does chemotherapy do?

Depending on your type of cancer and how advanced it is, chemotherapy can:
  • Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
  • Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
  • Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors that are causing pain or pressure.

How is chemotherapy used?

Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:
  • Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
  • Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.
  • Help radiation therapy and biological therapy work better.
  • Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).

Wednesday 23 October 2013

Anemia Part-7

Take the Blood Disorders Quiz

How is blood collected for a CBC?

Blood is collected by venipuncture (using a needle to draw blood from a vein) in a lab, hospital, or physician's office. Typically, blood is collected in a special sterile tube from an arm vein. The tube has some preservatives to prevent clotting of the blood. Results may be available in an hour or longer depending on the setting.
In some instances, a quick in office test called hemoglobin rapid test may be performed using a few drops of blood from a finger prick. The advantage of this quick test is that results may be obtained in a few minutes and only a few drops of blood may be required.

What is the red blood cell (RBC) count?

The red blood cells (RBCs or erythrocytes) are the most common type of cells in the blood. We each have millions and millions of these little disc-shaped cells. The RBC count is done to determine if the number of red blood cells is low (anemia) or high (polycythemia).
In an RBC count, the number and size of the RBCs are determined. This is usually reported as number of RBCs per a specified volume, typically in millions of RBCs in microliters (one one-thousandth of an ml) of whole blood. The shape of the RBCs is also evaluated under a microscope. All of this information, the number, size and shape of the RBCs, is useful in the diagnosis of anemia. Further, the specific type of anemia may be determined by this information.

What is hemoglobin?

Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and to blood. Functionally, hemoglobin is the key chemical compound that combines with oxygen from the lungs and carries the oxygen from the lungs to cells throughout the body. Oxygen is essential for all cells in the body to produce energy.
The blood also transports carbon dioxide, which is the waste product of this energy production process, back to the lungs from which it is exhaled into the air. The transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen to be transported to the tissues of the body.

Anemia Part-8

Take the Blood Disorders Quiz

What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If the hemoglobin level is too low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia).

What is the outlook (prognosis) for anemia?

Anemia generally has a very good prognosis and it may be curable in many instances. The overall prognosis depends on the underlying cause of anemia, its severity, and the overall health of the patient.

Tuesday 22 October 2013

Anemia Part-6

Take the Blood Disorders Quiz

What does a low hemoglobin level mean?

Low hemoglobin is called anemia. When there is a low hemoglobin level, there is often a low red blood cell count and a low hematocrit, too. Reference ranges are slightly different from one source to another, but typically hemoglobin of less than 13.5 gram/100 ml is abnormal in men and less than 12.0 gram/100 ml in women.

What is the hematocrit?

The hematocrit is specifically a measure of how much of the blood is made of red cells. The hematocrit is a very convenient way to determine whether the red blood cell count is too high, too low, or normal. The hematocrit is a measure of the proportion of blood that is composed of the red blood cells.

How is hematocrit determined?

The red blood cells in the sample of blood are packed down by spinning the tube in a centrifuge under prescribed conditions. The proportion of the tube that consists of red blood cells is then measured. Let's say that it is 45%. The hematocrit is 45%.

How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.
Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.
In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.
If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

Anemia Part-5


Take the Blood Disorders Quiz

How is anemia diagnosed?

Anemia is usually detected, or at least confirmed, by a complete blood cell (CBC) count. A CBC test may be ordered by a physician as a part of routine general checkup and screening or based on clinical signs and symptoms that may suggest anemia or other blood abnormalities.

What is a complete blood cell (CBC) count?

Traditionally, CBC analysis was performed by a physician or a laboratory technician by viewing a glass slide prepared from a blood sample under a microscope. Today, much of this work is often automated and done by machines. Six component measurements make up a CBC test:
  1. Red blood cell (RBC) count
  2. Hematocrit
  3. Hemoglobin
  4. White blood cell (WBC) count
  5. Differential blood count (the "diff")
  6. Platelet count
Only the first three of these tests -- the red blood cell (RBC) count, the hematocrit, and the hemoglobin -- are relevant to the diagnosis of anemia.
Additionally, mean corpuscular volume (MCV) is also often reported in a CBC, which basically measures the average volume of red blood cells in a blood sample. This is important in distinguishing the causes of anemia. Units of MCV are reported in femtoliters, a fraction of one millionth of a liter.
Other useful clues to causes of anemia that are reported in a CBC are the size, shape, and color of red blood cells.
Picture of Red Blood Cells

Monday 21 October 2013

Anemia Part-4

Take the Blood Disorders Quiz

Yes, anemia may be genetic. Hereditary disorders can shorten the life span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin (for example, alpha thalassemia and beta thalassemia).
Depending on the degree of the genetic abnormality, hereditary anemias may cause mild, moderate, or severe anemia. In fact, some may be too severe to be compatible with life and may result in death of the fetus (unborn infant). On the other hand, some of these anemias are so mild that they are not noticeable and are incidentally revealed during a routine blood work.

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:
  • Tired
  • Fatigue easily
  • Appear pale
  • Develop palpitations (feeling of heart racing)
  • Become short of breath
Additional symptoms may include:
  • Hair loss
  • Malaise (general sense of feeling unwell)
  • Worsening of heart problems
It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

Anemia Part-3


Take the Blood Disorders Quiz

What are other causes of anemia?

Some of the most common causes include:
  • Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons.
    • Strict vegetarians are at risk if they do not take adequate vitamin supplements.
    • Long-term alcoholics.
    • People who have abnormal structure or function of the stomach or intestines leading to impaired B12 absorption despite adequate intake.
This typically causes macrocytic (large blood cell volume) anemia. Vitamin B12, along with folate, is involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia as well. This may also be caused by inadequate absorption, under-consumption of green, leafy vegetables, and also long-term heavy alcohol use.
  • There can be rupture or destruction of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells. Examples of hemolytic anemia include hemolytic disease of the newborn, medication induced hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic anemia.
  • A wide assortment of bone marrow diseases can cause anemia.
    • For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
    • Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
    • Certain infections may involve the bone marrow and result in bone marrow impairment and anemia.
    • Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow.
    • Chronic alcohol consumption may lead to anemia via different pathways and thus, anemia is commonly seen in alcoholics.
  • Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with longstanding chronic diseases.

Sunday 20 October 2013

Anemia Part-2

Take the Blood Disorders Quiz

Can inadequate iron cause anemia?

Absolutely! As a matter of fact, iron deficiency is a very common cause of anemia. This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body's iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia.
Young women are likely to have low grade iron deficiency anemia because of the loss of blood each month through normal menstruation. This is generally without any major symptoms as the blood loss is relatively small and temporary.
Another common reason for iron deficiency anemia can be due to recurring or small ongoing bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding may be induced by medications, even very common over-the-counter drugs such as aspirin and ibuprofen (Advil, Motrin). Slow and chronic oozing from these ulcers can lead to loss of iron. Gradually, this could result in anemia. In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. Dizziness, lightheadedness, fatigue, confusion, shortness of breath, and even loss of consciousness can occur with severe, sudden blood loss anemia.

Saturday 19 October 2013

Anemia Part-1

Anemia facts*

*Anemia facts medical author: William C. Shiel Jr., MD, FACP, FACR
  • Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal.
  • For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.
  • Anemia is caused by either a decrease in production of red blood cells or hemoglobin, or an increase in loss or destruction of red blood cells.
  • Some patients with anemia have no symptoms. Others may feel tired, easily fatigued, appear pale, a feeling of heart racing, short of breath, and/or worsening of heart problems.
  • Anemia can be detected by a simple blood test called a complete blood cell count (CBC).
  • The treatment of the anemia varies greatly and very much depends on the particular cause.

What is anemia?

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These definitions may vary slightly depending on the source and the laboratory reference used.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.
Anemia is caused essentially through two basic pathways. Anemia is caused by either:
  1. a decrease in production of red blood cells or hemoglobin, or
  2. an increase in loss or destruction of red blood cells.
A more common classification of anemia (low hemoglobin) is based on the Mean Corposcular Volume (MCV) which signifies the average volume of individual red blood cells.
  1. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume).
  2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume).
  3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).
Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as to what could be the most common reason for anemia in each patient.
Picture of Red Blood Cells
Picture of Red Blood Cells
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 3/26/2012

Friday 18 October 2013

GastritisPart-3

Take the Tummy Trouble Quiz

 

GastritisPart-3

What are the treatment medications and home remedies for gastritis?

Treating the underlying cause of gastritis is the most effective way to reduce or resolve gastritis. For example, if the cause of gastritis is Helicobacter pylori, then treatment with appropriate antibiotics (usually a combination of amoxicillin and clarithromycin [Biaxin, Biaxin XL] plus bismuth subsalicylate [Pepto-Bismol]) should be effective.
If NSAIDs are the cause, then stopping the drug should be effective. However, other treatments are often used in addition to those that treat the specific cause. These treatments may reduce or stop symptoms of gastritis and allow gastric mucosal healing to begin regardless of the underlying cause. These medications include antacids (Maalox , Rolaids, and Alka-Seltzer), histamine (H2) blockers (famotidine [Pepcid AC], ranitidine [Zantac 75]) and PPI's or proton pump inhibitors (omeprazole [Prilosec], pantoprazole [Protonix], esomeprazole [Nexium]). They all function by different mechanisms to reduce acid in the stomach but usually do not treat the underlying cause of gastritis.

Thursday 17 October 2013

Gastritis Part-4

Take the Tummy Trouble Quiz

Gastritis Part-4

 

What are the complications of gastritis?

The complications of gastritis may occur over time, especially if gastritis becomes chronic and the underlying causes are not treated. Complications may include peptic ulcer, bleeding ulcers, anemia, gastric cancers, MALT lymphoma, gastric scarring, and strictures with outlet obstruction, dehydration, renal problems, and even death.

What is the prognosis of gastritis?

Most people that get gastritis have few or short-term symptoms and recover completely. Those people with underlying causes that are appropriately treated often recover completely. The prognosis of individuals with chronic disease and those who develop serious complications like bleeding ulcers, obstruction and cancer is more guarded.

How is gastritis prevented?

If the underlying cause of gastritis is preventable, then gastritis can be prevented. For example, if alcohol consumption or NSAIDs cause an individual's gastritis, prevention is accomplished by stopping the consumption of these agents. Avoidance may be preventive in situations where chemicals, radiation or some toxin ingestion could occur. It may be more difficult to prevent some infectious causes, but proper hygiene, hand washing, and eating and drinking only adequately cleaned or treated foods and fluids are healthy ways to decrease your risk of getting gastritis from infectious agents.

Gastritis


Take the Tummy Trouble Quiz 

Gastritis

What is gastritis?

Gastritis is inflammation of the lining of the stomach. Unfortunately, the term "gastritis" has been misused to include many different upper abdominal problems, but true gastritis refers to the stomach lining (gastric mucosa) that is inflamed. All or part of the gastric mucosa may be involved. Gastritis may be classified as acute or chronic. Acute gastritis maybe characterized as erosive (damaged areas where mucosal cells are disrupted or missing) and nonerosive. Chronic gastritis is determined by histopathology (appearance of the gastric mucosa). This article will focus on true gastritis. Gastritis has many causes, but most causes result in similar symptoms. This has leads to some confusion and is the reason why many health care professionals now consider the term "gastritis" as a non-specific description of a cluster of symptoms.


What causes gastritis?

A major cause of both acute and chronic gastritis is infection of the stomach mucosa by a bacterial species named Helicobacter pylori. Usually, this bacterium first infects the stomach antrum (stomach mucosa without acid-producing cells) acutely and may progress to infect most or all of the stomach's mucosa over time (chronic gastritis) and remain there for years. This infection generates an initial strong inflammatory response and eventually, a long-term chronic inflammation with intestinal cell changes may develop. Another major cause of acute and chronic gastritis is the use (and overuse) of nonsteroidal anti-inflammatory drugs (NSAIDs).
However, there are many other causes of gastritis; the following is a list of common causes of both acute and chronic gastritis; chronic gastritis may occur with repeated or continual presence of most of these causes:
  • Bacterial, viral and parasitic infections
  • Certain drugs (cocaine)
  • Alcohol
  • Bile reflux
  • Fungal infections
  • Allergic reactions
  • Stress reaction
  • Radiation
  • Certain food poisonings (infectious and chemical)
  • Trauma
In general, infectious agents, especially Helicobacter pylori, and NSAIDs are responsible for the majority of gastritis patients.


 

Wednesday 16 October 2013

Gastritis Part-2

Take the Tummy Trouble Quiz

Gastritis Part-2

 

What are the symptoms of gastritis?

Surprisingly in many people, gastritis often produces no symptoms and is diagnosed only when samples of the stomach mucosa are examined for other suspected diseases. However, when gastritis symptoms occur, the most common symptoms include abdominal pain (intermittent or constant burning, gripping or gnawing pain), often accompanied by nausea and vomiting and occasionally, diarrhea. Other symptoms such as loss of appetite, bloating, and burping or belching may occur. These latter symptoms come and go over time especially with chronic gastritis. Indigestion (dyspepsia) is another term that encompasses this cluster of symptoms.

How is gastritis diagnosed?

Gastritis is presumptively diagnosed by the patient's symptoms and history of a previous diagnosis and treatment of gastritis, alcohol consumption, and use of NSAIDs. Definitive diagnosis is made by identifying the underlying cause of the gastric mucosal inflammation and/or by tissue (gastric) biopsy. For example, the major infective cause of gastritis is Helicobacter pylori (H. pylori). This bacterium can be detected by breath, blood, stool, immunological and biopsy tests. Although the bacterium can be cultured from the patient, this is seldom attempted. Other pathogens can be identified using culture, stool and immunological tests.
Biopsy of the stomach mucosa, done during endoscopy examinations, is often used in patients to identify the causes of chronic gastritis and may allow visualization of mucosal erosions and other stomach mucosal changes. Abdominal X-rays or barium studies (upper or lower) may demonstrate the presence of thickened mucosa and folds that are signs of inflammation in the stomach.
Your doctor can help determine which tests should be done, including ancillary tests that may help identify other causes of the non-specific symptoms commonly found with gastritis.

Heart Disease Part-7

Heart Disease Part-7

View the Heart Disease Slideshow

Angioplasty and stenting

If the coronary angiogram (coronary=heart + angio=artery + gram=record) shows significant blockage in an artery, the cardiologist may attempt an angioplasty, in which a balloon is placed via a catheter (as with angiography) at the area of narrowing and when quickly inflated, compresses the offending plaque into the wall of the artery. Often a stent, or a metal cage, is placed at the site of angioplasty to keep the blood vessel from narrowing again. Should a stent be placed, patients are usually started on antiplatelet medication to prevent clot formation. Clopidogrel (Plavix) and prasugrel (Effient) are the two most common medications prescribed.

Surgery

For those patients with multiple coronary artery blockages, coronary artery bypass grafting may be a consideration.

Tuesday 15 October 2013

Heart Disease Part-6

Heart Disease Part-6

View the Heart Disease Slideshow

Modifying risk factors for heart disease

While patients cannot choose their family and alter their genetic predisposition to coronary artery disease, the rest of the risk factors are under control of the patient. Keeping blood pressure, cholesterol and other lipid levels, and diabetes under control needs to become a life-long goal. Smoking cessation is highly encouraged.

Medications

The purpose of medications for coronary artery disease is to allow more efficient heart muscle function to overcome any blockage that might exist.
Aspirin is one of the cornerstones of coronary artery disease treatment. It prevents platelets from clumping together when blood becomes turbulent, like when it flows past a narrowing in an artery.
Beta blockers prevent the action of adrenaline on the heart and allow the heart to beat a more efficiently by reducing the heart rate and causing the heart muscle to contract less aggressively. Examples of beta blockers include:
  • atenolol (Tenormin)
  • metoprolol (Lopressor, Toprol XL)
  • propranolol (Inderal, Inderal LA)
  • carvedilol (Coreg)
  • labetalol (Normodyne, Trandate)
Calcium channel blockers can also be used to control heart rate and allow the heart to beat more efficiently. Examples of calcium channel blockers include:
  • diltiazem (Cardizem, Dilacor, Tiazac)
  • verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS)
Nitroglycerin dilates blood vessels and may be used sublingually, under the tongue, to treat angina. Some patients may be prescribed long-acting nitroglycerin to help control anginal symptoms.

Monday 14 October 2013

Heart Disease Part-5

View the Heart Disease Slideshow

 

Heart Disease Part-5

Heart catheterization or coronary angiography

This test is the gold standard for the diagnosis of coronary artery disease. A cardiologist inserts and then threads a small tube through the groin or arm into the coronary arteries, where dye is injected to directly visualize the arteries on an x-ray. This test defines the anatomy of the coronary arteries. At the time of the catheterization, if blockages are found, they may be potentially treated with angioplasty in which a balloon is inflated to squash the plaque into the blood vessel wall and the insertion of a stent (wire cage that prevents the blood vessel from narrowing again).
CT coronary angiogram may be used test to diagnose coronary artery disease. During this procedure, intravenous dye containing iodine is injected into the patient and CT scanning is performed to image the coronary arteries.
Prior to the angiogram, a calcium score may be obtained. The calcium CT scan can measure the amount of calcium within heart blood vessels. If the score is 0, meaning that there is no calcium present, the risk of having heart disease is zero. The higher the score, the increased risk of narrowed coronary arteries.

What is the treatment for heart disease?

Coronary artery disease is usually treated in a multi-step approach depending upon a patient's symptoms. The patient and healthcare provider need to work together to return the patient to a normal lifestyle.

Prevention of heart disease

Comment on this
The key to the treatment is prevention. A healthy lifestyle includes exercise, proper nutrition, and smoking cessation. Moreover, controlling diabetes and high blood pressure to minimize contribution risk for heart disease is a major aspect of prevention.
An aspirin a day is recommended to decrease the risk for heart disease and should be started with the recommendation of a health care practitioner.
A little alcohol (one drink per day for women or two drinks per day for men) decreases the risk of heart disease compared to nondrinkers. However, it is not recommended that nondrinkers begin drinking.

Heart Disease Part-4

View the Heart Disease Slideshow

 

Heart Disease Part-4

Echocardiography

Used with or without exercise, echocardiography can assess how the heart works. Using sound waves to generate an image, a cardiologist can evaluate many aspects of the heart. Echocardiograms can examine the structure of the heart including the heart valves, the thickness of the heart muscle, the septum (the tissues that separate the four heart chambers from each other) and the pericardial sac (the outside lining of the heart).
The test can indirectly assess blood flow to parts of the heart muscle. If there is decreased blood flow, then segments of the heart wall may not beat as strongly as adjacent heart muscle. These wall motion abnormalities signal the potential for coronary artery disease.
The echocardiogram can also assess the efficiency of the heart by measuring ejection fraction. Normally when the heart beats, it pushes more than 60% of the blood in the ventricle out to the body. Many diseases of the heart, including coronary artery disease, can decrease this percentage (the ejection fraction).

Perfusion studies

Radioactive chemicals like thallium or technetium can be injected into a vein and their uptake measured in heart muscle cells. Abnormally decreased uptake can signify decreased blood flow to parts of the heart because of coronary artery narrowing. This test may be used when the patient's baseline EKG is not normal and is less reliable when used to monitor a stress test.

Computerized tomography

The latest generation of CT scanners can take detailed images of blood vessels and may be used as an adjunct to determine whether coronary artery disease is present. In some institutions, the heart CT is used as a negative predictor. That means that the test is done to prove that the coronary arteries are normal rather than to prove that the disease is present.

Sunday 13 October 2013

Heart Disease Part-3

View the Heart Disease Slideshow

 Heart Disease Part-3

How is heart disease diagnosed?

The diagnosis of heart disease begins with obtaining a history that the potential for coronary artery disease exists. Risk factors need to be assessed and risk stratification occurs. The type of testing that is recommended, if any, depends upon the potential that the patient's symptoms actually represent angina and are coming from the heart.
Heart disease tests
Not every patient with chest pain needs heart catheterization (the most invasive test). Instead, the healthcare provider will try to choose the testing modality that will best provide the diagnosis, and if coronary artery disease is present, decide what impairment, if any, is present.

Electrocardiogram (ECG or EKG)

The heart is an electrical pump, and the electrical impulses it generates can be detected on the surface of the skin. Normal muscle conducts electricity in a reproducible fashion. Muscle that has decreased blood supply conducts electricity poorly. Muscle that has lost its blood supply and has been replaced with scar tissue cannot conduct electricity. The electrocardiogram (EKG) is a noninvasive test used to reflect underlying heart conditions by measuring the electrical activity of the heart.
Some people have "abnormal" EKGs at baseline but this may be normal for them. It is important that an electrocardiogram be compared to previous tracings if one is available. If a patient has a baseline abnormal EKG, they should consider carrying a copy with them for reference should they ever need another EKG.

Stress testing

If the baseline EKG is relatively normal, then monitoring the EKG tracing while the patient exercises may uncover electrical changes that may indicate the presence of coronary artery disease. There are a variety of testing protocols used to determine whether the exercise intensity is high enough to prove that the heart is normal.
Some patients are unable to exercise on a treadmill, but they can still undergo cardiac stress testing by using intravenous medication that causes the heart to work harder.
Stress testing is done under the supervision of medical personnel because of the potential of provoking angina, shortness of breath, abnormal heart rhythms, and heart attack.

Heart Disease- Part-2

View the Heart Disease Slideshow

Heart Disease- Part-2

What are the symptoms of heart disease?

The typical symptoms of coronary artery disease are chest pain associated with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of signs and symptoms, and there may not even be specific chest pain. Other locations of pain and other symptoms may include shoulder or back ache, upper abdominal pain, nausea, and indigestion.
Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue and generalized weakness and the inability to complete routine physical tasks such as walking or climbing stairs.
Health care practitioners and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain. Health care practitioners may misinterpret these symptoms when patient answers "no" to the question whether "pain is present," even though the patient is experiencing other types of discomfort.
People with coronary artery disease usually have gradual progression of their symptoms. As an artery narrows over time, the symptoms of decreased blood flow to part of the heart muscle may increase in frequency and/or severity. Health care practitioners may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?), and whether there has been an acute change in the symptoms.
Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care.
Picture of the Heart and Heart Attack

Saturday 12 October 2013

Heart Disease- Part-1

View the Heart Disease Slideshow

Heart Disease- Part-1

Heart disease facts

  • Heart disease refers to several conditions that affect the heart and blood vessels. Arrhythmias, heart valve disease, congenital heart defects, and inflammation of the heart or its lining (the pericardium) are all diseases that affect the heart. However, this article will focus on the most common type of heart disease, coronary artery disease (CAD), also known as atherosclerotic heart disease (ASHD).
  • Coronary artery disease is the most common cause of death in the United States. Over a million people each year will have a heart attack and 25% will die before they get to the hospital while or in the Emergency Department.
  • Prevention is the key to treatment of heart disease.
  • Diagnosis of heart disease is often made by careful history taken by a health care practitioner. Some individuals may have atypical symptoms, including almost none at all.
  • The testing strategy to confirm the diagnosis and plan appropriate treatment needs to be individualized for each patient diagnosed with heart disease.
  • Treatment of heart disease depends upon the severity of disease, and is often directed by the symptoms experienced by the affected individual.

Introduction to heart disease

The heart is like any other muscle, requiring oxygen and nutrient-rich blood for it to function. The coronary arteries that supply blood to the heart muscle spread across the surface of the heart, beginning at the base of the aorta and branching out to all areas of the heart muscle.
The coronary arteries are at risk for narrowing as cholesterol deposits, called plaques, build up inside the artery. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina.

apixaban, Eliquis

apixaban, Eliquis

View the Atrial Fibrillation Slideshow Pictures

GENERIC NAME: apixaban

BRAND NAME: Eliquis

DRUG CLASS AND MECHANISM: Eliquis is an oral drug used for preventing blood clots in patients with atrial fibrillation. It is an anticoagulant that works by blocking the action of factor Xa. Factor Xa is an important protein in the coagulation cascade that causes blood to clot. Reducing the action of factor Xa reduces the ability of blood to clot. In patients with atrial fibrillation there is increased risk of blood clots which can travel to the brain where it causes strokes as well as to other organs. Eliquis reduces this risk. The FDA approved Eliquis in December 2012.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 2.5 and 5 mg
STORAGE: Apixaban should be stored at room temperature between 15 C to 30 C (59 F to 86 F).
PRESCRIBED FOR: Eliquis is used for reducing the risk of strokes and blood clots in patients with atrial fibrillation who have no problems with their heart valve (nonvalvular atrial fibrillation).
DOSING: The usually recommended dose is 5 mg by mouth twice daily. The dose for individuals 80 years or older, weighing less than or equal to 60 kg, or with reduced kidney function is 2.5 mg twice daily.
DRUG INTERACTIONS: Blood levels of apixaban are increased by drugs that reduce the activity of the liver enzymes that break down apixaban. The dose of apixaban should be reduced to 2.5 mg twice daily if combined with drugs that reduce the activity of these enzymes. Examples include ketoconazole (Nizoral, Extina, Xolegel, Kuric), itraconazole (Sporanox), ritonavir (Norvir), and clarithromycin (Biaxin, Biaxin XL).
Drugs that increase the breakdown of apixaban reduce its blood levels and its effectiveness. Examples include carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), rifampin, St. John's Wort, and phenytoin (Diantin, Dilantin-125. They should not be combined with apixaban.
Administration of other drugs that also can prevent clotting will increase the risk of bleeding during treatment with apixaban. Examples include aspirin, heparin, chronic use of NSAIDs, and drugs that breakdown blood clots (fibrinolytics).
PREGNANCY: There are no adequate studies in pregnant women. Use during pregnancy may increase the risk of bleeding during pregnancy and delivery.
NURSING MOTHERS: It is not known if apixaban is excreted in human milk. Nursing mothers should discontinue apixaban or discontinue nursing.
SIDE EFFECTS: The most common side effects of apixaban involve bleeding. These include bleeding in the stomach, intestines, brain, and eyes; the bleeding may be fatal. Major bleeding events were fewer in patients who received apixaban when compared to a similar group that received warfarin (Coumadin), another widely used drug for preventing blood clots. Rash and serious allergic reactions also may occur.

Tuesday 8 October 2013

Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?


 

Eating peanut butter regularly as a preteen and teen girl appears to decrease the risk of developing benign breast disease as an adult, new research has found.
Benign breast disease -- noncancerous changes in the breast tissue -- is a risk factor for breast cancer, experts agree.
The researchers followed more than 9,000 females, beginning when they were aged 9 to 15 in 1996, until 2010, when they were young women. Eating peanut butter three days a week reduced the risk of developing benign breast disease by 39 percent, said Dr. Graham Colditz, senior study author.
"I think this gives us enormous hope there are strategies we could be following to help prevent breast cancer that we haven't capitalized on yet," said Colditz, the associate director for cancer prevention and control at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, in St. Louis.
The study, published online Sept. 17 in Breast Cancer Research and Treatment, was funded by the Breast Cancer Research Foundation and the U.S. National Institutes of Health.
Benign breast disease is fairly common, and a known risk factor for breast cancer, Colditz said. Before menopause, "about one in four women have a benign lesion, confirmed by biopsy," he said. "It's very clear there is a strong link between the benign lesion and the subsequent risk of invasive breast cancer."
Depending on the characteristics of the benign lesion, he said, benign breast disease could increase breast cancer risk by threefold.
News Picture: Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?The study participants were part of a long-term, ongoing study on the health effects of diet and exercise in young people. They filled out questionnaires about their diet annually from 1996 until 2001, then four more times until 2010. They also reported if they had been diagnosed with benign breast disease. In all, 112 women said they had.
The researchers looked at foods with vegetable protein and vegetable fats, then focused on individual foods, including peanut butter, peanuts or other nuts, beans and corn.
A daily serving of any of these foods was linked with a 68 percent reduced risk of benign breast disease. At age 14, a daily serving of any of those foods was linked with a 66 percent lower risk of benign breast disease, and girls who had about three servings a week of peanut butter had a 39 percent lower risk.
The researchers found a link between eating peanut butter and lower breast disease risk, not a cause-and-effect relationship, and Colditz said he can't explain yet why the peanut butter seems protective.
"It could well be the protein," he said. In previous studies, the researchers have looked at other factors of a healthy diet, such as milk consumption, and their role in breast health. The peanut butter finding, he said, is strong, even when taking into account an overall healthy diet. "It's not something we can make go away," he said.
For now, Colditz said, the take-home message is for teens and preteens to substitute peanuts and peanut butter for less-healthy snacks such as cookies.
Another expert who reviewed the findings said the study is well done.
Dr. Steven Chen, an associate clinical professor of breast and endocrine surgery at the City of Hope Comprehensive Cancer Center, in Duarte, Calif., said that while lowering benign breast disease does lower breast cancer risk, many other factors increase breast cancer risk besides benign breast disease.
"It's always good to lower any risk [of breast cancer] you can, but whether peanut butter intake will have a major impact on developing breast cancer down the line, only time will tell," Chen said.
As for how to explain the link? "It's hard to say at this point," Chen said, adding that in countries where less meat is eaten, less breast cancer risk is reported. Based on the study findings, he said, teen girls and preteens "shouldn't avoid peanut butter and nuts if they are not allergic." Getting some protein through vegetables, which was also looked at in the study, is a good idea, too, he added.

Monday 7 October 2013

WebMD Resources for Affordable Care Act Enrollment



 Today the online "doors" swing open on the new health insurance Marketplaces. In every state and in Washington, D.C., millions of uninsured Americans will be able to shop for and buy health insurance offered through the Affordable Care Act. Despite years of preparation, that's news to most Americans. More than 70% of people without insurance don't realize that today is opening day of a 6-month open enrollment period, according to a poll by the Kaiser Family Foundation.

Whether you know about the Marketplaces or are learning about them for the first time, WebMD has a number of resources ready to help. They include:
  • Live chat today, noon to 1 p.m.: Our experts answer questions live about Day 1 of enrollment.
  • WebMD Answers: Health care reform experts give timely answers to your questions.
  • Health Insurance Advisor: This tool will help you compare plans specific to your health needs.
  • State Marketplace Map: Learn more about what's offered in your state.
  • Affordable Care Act Center: Tools and resources to help you understand the health care reform law.

More Evidence That Exercise Can Help Prevent High Blood Pressure


 

Exercising during your leisure time could help prevent high blood pressure, but being physically active at work doesn't seem to provide the same benefit, according to a new review.
Researchers analyzed the findings of 13 studies that examined the effects of physical activity on blood pressure. The studies included a total of nearly 137,000 people in the United States, Europe and East Asia who initially had healthy blood pressure. During follow-up periods ranging from two to 45 years, more than 15,600 of the participants developed high blood pressure.
Compared to people who exercised less than one hour a week during their leisure time, the risk of developing high blood pressure was 11 percent lower among those who exercised one to three hours per week, and 19 percent lower among those who did more than four hours of recreational exercise a week, according to the study published Sept. 30 in the journal Hypertension.
The results suggest that the more leisure-time exercise you do, the lower your risk of developing high blood pressure.
News Picture: More Evidence That Exercise Can Help Prevent High Blood PressureHowever, the researchers did not find a solid link between physical activity at work and high blood pressure risk. Physical activity on the job, such as farm or industrial work, can involve heavy lifting, prolonged standing and repetitive tasks.
Exercise guidelines don't distinguish between physical activity at work or during leisure time, but "given the new findings, perhaps they should," study co-author Dr. Bo Xi, a lecturer at the Shandong University School of Public Health in Jinan, China, said in a journal news release.
Recreational exercise may help reduce the risk of high blood pressure by preventing weight gain, improving poor insulin sensitivity or reducing the blood vessels' resistance to blood flow, the researchers suggested.
But they noted that their findings don't show that leisure-time exercise actually prevents high blood pressure. People who exercise for fun may just have healthier lifestyles, Xi explained.
About 78 million U.S. adults have high blood pressure, which is a risk factor for heart and kidney disease.

Cholesterol Drugs May Boost Your Gums' Health, Too

 

The statin medications you take for your heart may have an unexpected side benefit: They help reduce inflammation of the gums, according to new research.
Using advanced imaging techniques, researchers were able to see that when people with gum disease took higher doses of the commonly prescribed cholesterol-lowering drugs, their gum inflammation decreased.
During the 12-week study, the researchers also looked for evidence of inflammation or hardening of the blood vessels (atherosclerotic disease) in the study volunteers, and they found that reduced gum inflammation was correlated with improved blood vessel health.
"There is a building, growing body of literature that draws a line between gum disease and atherosclerotic disease. In our study, benefits in the gums correlated with benefits in the arteries," said the study's senior author, Dr. Ahmed Tawakol, co-director of the Cardiac Imaging Trials Program at Massachusetts General Hospital and Harvard Medical School in Boston. "People with [gum disease] and atherosclerotic disease should likely be that much more vigilant in treating their gum disease."
The study was published online Oct. 2 in the Journal of the American College of Cardiology. Funding was provided by drug manufacturer Merck and Co., which does not produce the statin used in this study.
Currently, statins are prescribed to lower high levels of "bad" cholesterol, also known as LDL cholesterol. When there's too much LDL cholesterol, it can start to build up on blood vessel walls, leading to hardening of the arteries.
News Picture: Cholesterol Drugs May Boost Your Gums' Health, TooIn the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.
According to editorial author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, a "consistent stream of data" shows that statins have benefits beyond their cholesterol-lowering properties.
"There are three big categories of how statins likely exert their effects: lowering LDL, reducing inflammation, and by modulating plaque," said Blaha.
The current study lends support to the idea that statins can reduce inflammation. It included 83 adults who had risk factors for, or already had, atherosclerosis. They were randomly assigned to take either 10 or 80 milligrams of a statin called atorvastatin (brand name Lipitor) for three months.
Everyone underwent imaging at the start of the study, again after four weeks and then at 12 weeks.
At the end of the study, the investigators had complete data on 59 people. They found a significant reduction in gum inflammation for the people taking 80 mg of atorvastatin compared to those on the 10-mg dose. Changes began as early as four weeks after people started taking the higher-dose drug.
There was a more significant reduction in gum inflammation for people who had more serious gum disease at the start of the study and took a higher dose of the statin. The researchers also found that a reduction in gum inflammation correlated with reduced blood vessel inflammation.
"It was really those on the higher-dose statins that had the benefit," noted Tawakol. But, "I would not recommend the use of statins outside the current guidelines," he added. "We see this trial more as a proof-of-principle trial. Our findings need to be confirmed in a larger clinical trial."
Still, he said, there's little harm in telling people to take care of gum disease. "Patients with known heart disease and known gum disease should have their gum disease evaluated and treated," Tawakol said.

Daily Walk May Cut Your Breast Cancer Risk

FRIDAY, Oct. 4 (HealthDay News) -- Older women who walk every day may reduce their risk of developing breast cancer. And those who exercise vigorously may get even more protection, according to new research.
The study of more than 73,000 postmenopausal women found that walking at a moderate pace for an hour a day was associated with a 14 percent reduced breast cancer risk, compared to leading a sedentary lifestyle. An hour or more of daily strenuous physical activity was associated with a 25 percent reduced risk, the study found.
This is welcome news for women who aren't very athletic.
"The nice message here is, you don't have to go out and run a marathon to lower your breast cancer risk," said study researcher Alpa Patel, senior epidemiologist at the American Cancer Society, which funded the study.
"Go for a nice, leisurely walk an hour a day to lower risk," Patel advised.
Breast cancer is the leading cancer among women. In the United States, about one in eight women will develop the disease in her lifetime.

News Picture: Daily Walk May Cut Your Breast Cancer RiskWhen they enrolled in 1992, the average age was nearly 63. The women completed a questionnaire about medical, environmental and demographic factors at the start and repeated the reports every two years between 1997 and 2009. The study participants also reported on their physical activity and time spent sitting, including watching television and reading, and reported any diagnosis of breast cancer.
During the follow-up, which was roughly 14 years, 4,760 women developed breast cancer.
The researchers compared the exercise habits of women who developed breast cancer and those who did not. About 9 percent never participated in physical activity, while about half reported walking as their sole activity.
Those who walked seven hours or more a week, even without engaging in other recreational physical activity, reaped protective benefits compared to those who walked three hours or less a week.
The message is encouraging, Patel said.
However, the study only found an association between moderate exercise and reduced breast cancer risk, not a direct cause-and-effect relationship.
While other studies have found that exercise lowered risk of breast cancer more for women with a lower body mass index (BMI) -- a calculation of body fat based on height and weight -- this study found the effect held regardless of BMI, weight gain in adulthood or use of postmenopausal hormone therapy.
Other studies have found a link between time spent sitting and breast cancer risk, but Patel's group did not find this link.
This is "a good news study for women," said another cancer expert, Dr. Laura Kruper, who was not involved with the research.
The findings add to the accumulating evidence about exercise lowering breast cancer risk, and present a goal that is reachable for most women, said Kruper, co-director of the breast cancer program at the City of Hope Cancer Center in Duarte, Calif.
"This is something nearly every woman can do," Kruper said of exercising moderately for an hour daily.
"This is not running a marathon," she said.
Her advice to sedentary women who want to reduce their breast cancer risk: "If you get off the couch and walk around, it would help."
Why does exercise appear to lower breast cancer risk? The mechanism is mostly hormonal, Patel said. Breast cancer risk is affected by lifetime exposure to estrogen, with more exposure increasing risk. Older, physically active women have lower levels of estrogen than their sedentary peers.
Besides exercising, women who want to reduce breast cancer risk should maintain a healthy body weight, Patel said, and if they drink, they should limit alcoholic beverages to no more than one daily.