Monday, April 15, 2019

How to Understand Your Lab Results

A laboratory (lab) test is a procedure in which a health care provider takes a sample of your blood, urine, other bodily fluid, or body tissue to get information about your health. Some lab tests are used to help diagnose, screen, or monitor a specific disease or condition. Other tests provide more general information about your organs and body systems. Lab tests play an important role in your health care. But they don't provide a complete picture of your health. Your provider will likely include a physical exam, health history, and other tests and procedures to help guide diagnosis and treatment decisions.

Lab tests are used in many different ways. Your health care provider may order one or more lab tests to:
Diagnose or rule out a specific disease or condition

Screen - A screening test can show if you are at a higher risk for getting a specific disease. It can also find out if you have a disease, even if you have no symptoms.

Monitor a disease and/or treatment - If you've already been diagnosed with a disease, lab tests can show if your condition is getting better or worse. It can also show if your treatment is working.
Check your overall health - Lab tests are often included in a routine checkup.

Lab results are often shown as a set of numbers known as a reference range. A reference range may also be called "normal values." You may see something like this on your results: "normal: 77-99mg/dL". Reference ranges are based on the normal test results of a large group of healthy people. The range helps show what a typical normal result looks like. But not everyone is typical. Sometimes, healthy people get results outside the reference range, while people with health problems can have results in the normal range. If your results fall outside the reference range, or if you have symptoms despite a normal result, you will likely need more testing. Your lab results may also include one of these terms:
  • Negative or normal, which means the disease or substance being tested was not found
  • Positive or abnormal, which means the disease or substance was found
  • Inconclusive or uncertain, which means there wasn't enough information in the results to diagnose or rule out a disease. If you get an inconclusive result, you will probably get more tests. Tests that measure various organs and systems often give results as reference ranges, while tests that diagnose or rule out diseases often use the terms listed above.

Wednesday, April 10, 2019

Wisdom Wednesday: Metformin for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis


Clinical Question
How effective is metformin in the treatment of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis?

Evidence-based Answer
Metformin does not seem to be an effective treatment for nonalcoholic steatohepatitis. There are no studies evaluating whether metformin improves long-term patient-oriented outcomes such as progression from NAFLD to nonalcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, or death from liver failure. Metformin does not improve anatomic outcomes (histologic or ultrasound features of the liver) or biochemical outcomes (alanine transaminase [ALT] and aspartate transaminase [AST] levels, or insulin resistance) in adults. Metformin does not improve liver histologic or biochemical outcomes, or body mass index (BMI) in adults with nonalcoholic steatohepatitis. (Strength of Recommendation: C, based on a meta-analysis of randomized, controlled trials [RCTs] evaluating laboratory parameters.) Similarly, metformin does not improve histologic or biochemical outcomes, or BMI in children and adolescents with NAFLD. (Strength of Recommendation: C, based on RCTs evaluating laboratory parameters.)

Evidence Summary
Adults With NAFLD
No studies have evaluated patient-oriented outcomes of metformin therapy for NAFLD or nonalcoholic steatohepatitis. An RCT found no improvement in liver histology on biopsy.[1,2] Two placebo-controlled RCTs (N = 113) evaluating the effect of metformin (850 to 1,700 mg per day) on ALT and AST levels, insulin resistance, and BMI found no differences. One RCT (n = 48) found a small decrease in BMI. Another RCT (n = 2,153) found no improvement in ALT levels after treatment with metformin (850 mg twice per day) vs. placebo.[2]

Adults With Nonalcoholic Steatohepatitis
Two RCTs (N = 52) evaluating metformin (500 to 1,000 mg per day) in patients with nonalcoholic steatohepatitis found that it did not improve liver histology, ALT and AST levels, BMI, or insulin resistance.[1,3]

Children With NAFLD
Two RCTs (N = 172) evaluating metformin (1,000 to 1,500 mg per day) vs. placebo in children with obesity and NAFLD found no improvement in liver histology on biopsy, ALT and AST levels, BMI, or insulin resistance.[4,5] A smaller RCT (n = 50; mean age: 15 years) found that metformin (850 mg twice per day) improved ultrasound scores for fatty liver but did not improve ALT and AST levels.[6]

Recommendations From Others
An evidence-based guideline from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the American Gastroenterological Association states that metformin has no significant effect on liver histology and is not recommended as a treatment for liver disease in adults with nonalcoholic steatohepatitis.[7]

Monday, April 8, 2019

How Sugary Drinks Fuel Cancer

Researchers acknowledge that obesity increases the risk of cancer, and some studies even consider the existence of a causal relationship between this metabolic condition and cancer.

One important factor that can lead to obesity is the high intake of sugar through the frequent consumption of processed foods and sugary beverages. However, so far, there has been limited research looking at the effects of sugar on tumor growth independently of obesity.
Now, a team of specialists from Baylor College of Medicine in Houston, TX and Weill Cornell Medicine in New York City, NY has collaborated with colleagues from other research institutions to identify a clear link between sugary drinks and the accelerated growth of tumors in colorectal cancer.

In the new study, the results of which appeared yesterday in the journal Science, the research team studied the effects of high-fructose corn syrup in mouse models of colorectal cancer.

The team opted for a solution of 25-percent high-fructose corn syrup because this is the type of sweetener that manufacturers most commonly used as an ingredient in popular soft drinks.

"The current thought is that sugar is harmful to our health mainly because consuming too much can lead to obesity," explains co-author Jihye Yun, who is an assistant professor of molecular and human genetics at Baylor College of Medicine. "We know that obesity increases the risk of many types of cancer, including colorectal cancer; however, we were uncertain whether a direct and causal link existed between sugar consumption and cancer."

The team conducted the research in mice with early-stage colorectal cancer in which they deleted a gene called "Apc." This gene encodes a protein with the same name, and its deletion simulated a mutation that characterizes fast-growing colon cancer in humans. "More than 90 percent of colorectal cancer patients have this type of Apc mutation," the researcher points out.

In the first stage of the study, the researchers allowed the mice to drink the sugary beverage freely. As a result, the rodents put on a lot of weight within just 1 month.

To determine whether or not the corn syrup would boost cancer growth independently of obesity, the team then decided to administer the sugary drink in a way that would allow the mice to ingest it without putting on weight. So, the researchers gave the mice the sugary drink orally through a specially designed syringe once a day for 2 months.

Following this 2-month intervention, the investigators observed that the rodents had not put on too much weight, but they had indeed developed larger, more advanced tumors than the rodents who had only received water.

Wednesday, April 3, 2019

Wisdom Wednesday: Continuing ARB Recalls Shake Up Hypertension, HF Care


Concerns over ongoing recalls of angiotensin II receptor blockers (ARBs) are forcing physicians and patients to choose between optimal treatments and rattling confidence in the safety of the generic drug supply itself.

"I see hypertension on a regular basis and on any given clinic day, four to five patients have either stopped their medicines or have considered stopping their medicines and a separate detailed conversation has to be put in place to try to convince them to continue," Keith Ferdinand, MD, Tulane University Heart and Vascular Institute, New Orleans, told theheart.org | Medscape Cardiology.

ARBs are recommended for the treatment of hypertension, heart failure, and chronic kidney disease, with more than 61 million prescriptions written for valsartan, losartan, and irbesartin in the United States in 2016, according to the federal ClinCalc DrugStats database.

Ongoing US Food and Drug Administration (FDA) recalls — all in generic ARB-containing products — began last July when the probable carcinogen N-nitrosodimethylamine (NDMA) was detected in the valsartan active pharmaceutical ingredient (API) supplied by Zhejiang Huahai Pharmaceuticals (ZHP), Linhai, China.

Within months, the rolling recalls had extended to irbesartan- and losartan-containing products. A second probable carcinogen, N-nitrosodiethylamine (NDEA), was identified last fall and a third, N-nitroso-N-methyl-4-aminobutyric acid (NMBA), only last month.

Monday, April 1, 2019

When to Consume Protein

We all need protein as part of a balanced diet and to stay healthy. Some people consume protein for specific reasons, such as to help them lose weight or gain muscle mass. However, it is not yet clear when the best time is to have that protein. There is some evidence that consuming protein can help a person lose weight, and there is clear evidence that it can help people build muscle mass if they also exercise. However, research, as yet, does not make it unclear when is the best time to have protein. It is also unclear if there is any best time at all, why this is the case, or whether it is the case for everyone.

Most people in the United States get enough protein in their diet. Still, the United States Department of Agriculture (USDA) say many people should vary the types of food containing protein that they eat. If a person is trying to build muscle mass, they may also take protein in the form of supplements to help them build muscle tissue after exercise.

There is some evidence that eating protein can help a person lose weight. Evidence suggests protein does this in part by increasing satiety. Satiety is the feeling of being full. Currently, there is little solid evidence regarding when the best time to eat protein might be to encourage weight loss. For example, researchers published a study in the journal Advances in Nutrition suggesting that eating snacks that contain protein may reduce the number of calories a person consumes at their next meal. However, the research paper also points out that studies demonstrating this are scarce and sometimes conflicting. They suggest more studies are needed to confirm their findings.

Wednesday, March 27, 2019

Wisdom Wednesday: The 'London Patient' New HIV Remission Raises Hope


A London man has not had detectable HIV in his system for 18 months, despite not having received treatment during that period. The remission came after the patient underwent a stem cell transplant. This makes him the second man in history — after the Berlin patient — to have achieved HIV remission after such a transplant. And that has raised questions about whether he might be cured of HIV.

"The Berlin patient was not an anomaly," Ravindra Gupta, MD, from University College London, and his team write in their report published online today in Nature. But it is unlikely that this will lead to widespread stem cell transplants for people infected with HIV, said Gupta It is only "a small step in the right direction," he told Medscape Medical News. "But with enough small steps, we can get where we need to be."

As well as HIV, both Berlin patient Timothy Brown and the new patient — referred to as the London patient — had acute cancers that called for a stem cell transplant, a painful and invasive treatment used after other treatments have failed. For Brown, it was leukemia. For the London patient, it was stage 4 Hodgins’s lymphoma, a non-AIDS-related cancer more common among people with HIV. Both patients also had stem cell donors with two genetic mutations that remove the CCR5 receptor from the surface of the CD4 T-cell. Without that receptor, most HIV strains can't gain access to the cell and can't spread, and — bingo — that's the end of HIV.

Monday, March 25, 2019

Lifestyle Changes Do a Number on PSA Values

Simple, temporary lifestyle changes may be able to spare men with mildly increased prostate-specific antigen (PSA) levels from having to endure a prostate biopsy, results of a controlled study suggest.

Men who avoided eating spicy foods, drinking alcohol or coffee, and riding a bicycle had a repeat PSA reading approximately 1.5 ng/mL lower than their first reading a median of 8 weeks earlier.

Nearly half of men who adopted the lifestyle changes had a drop-in PSA below the minimum threshold for biopsy, reported Alexandre Zlotta, MD, director of Uro-Oncology at Mount Sinai Hospital and professor of surgery (urology) at the University of Toronto, Ontario, Canada.
In an interview with Medscape Medical News here at the European Association of Urology (EAU) 2019 Congress, Zlotta said that spicy food has something in common with alcohol, caffeine, and biking. "Spicy food induces inflammation, and inflammation directly translates into increase in PSA," he said.

Zlotta explained that repeat biopsy decisions are not based on a single PSA but that the new intervention might be a good idea before a repeat PSA test.