A new study has found that Vitamin D, readily available in supplements or cod liver oil, can counter the effects of Crohn’s disease. John White, an endocrinologist at the Research Institute of the McGill University Health Center, led a team of scientists from McGill University and the Université de Montréal who present their findings about the inflammatory bowel disease in the latest Journal of Biological Chemistry.

“Our data suggests, for the first time, that Vitamin D deficiency can contribute to Crohn’s disease,” says Dr. White, a professor in McGill’s Department of Physiology, noting that people from northern countries, which receive less sunlight that is necessary for the fabrication of Vitamin D by the human body, are particularly vulnerable to Crohn’s disease.

Vitamin D, in its active form (1,25-dihydroxyvitamin D), is a hormone that binds to receptors in the body’s cells. Dr. White’s interest in Vitamin D was originally in its effects in mitigating cancer. Because his results kept pointing to Vitamin D’s effects on the immune system, specifically the innate immune system that acts as the body’s first defense against microbial invaders, he investigated Crohn’s disease. “It’s a defect in innate immune handling of intestinal bacteria that leads to an inflammatory response that may lead to an autoimmune condition,” stresses Dr. White.

What Vitamin D does

Dr. White and his team found that Vitamin D acts directly on the beta defensin 2 gene, which encodes an antimicrobial peptide, and the NOD2 gene that alerts cells to the presence of invading microbes. Both Beta-defensin and NOD2 have been linked to Crohn’s disease. If NOD2 is deficient or defective, it cannot combat invaders in the intestinal tract.

What’s most promising about this genetic discovery, says Dr. White, is how it can be quickly put to the test. “Siblings of patients with Crohn’s disease that haven’t yet developed the disease might be well advised to make sure they’re vitamin D sufficient. It’s something that’s easy to do, because they can simply go to a pharmacy and buy Vitamin D supplements. The vast majority of people would be candidates for Vitamin D treatment.”

“This discovery is exciting, since it shows how an over-the-counter supplement such as Vitamin D could help people defend themselves against Crohn’s disease,” says Marc J. Servant, a professor at the Université de Montréal’s Faculty of Pharmacy and study collaborator. “We have identified a new treatment avenue for people with Crohn’s disease or other inflammatory bowel diseases.”

This study was funded by a grant from McGill University.

Source
MedicalNewsToday

Surgical operation

Basketball players, baseball pitchers, and athletes warm up before they perform, and now researchers in the US are investigating whether surgeons should do the same to ensure they are better prepared for when they have to perform.

Dr. Tom Lendvay, assistant professor in the Department of Urology at the University of Washington in Seattle thinks there could be something in this idea, and to this end the US Army Medical Research and Material Command has awarded him some funds to study the effect of pre-operative warm-up on virtual reality surgical task proficiency.

Maj. Timothy Brand, a surgeon based at Madigan Army Medical Center in Tacoma, Washington, is collaborating with Lendvay on the study.

Lendvay, who is also co-director of Seattle Children’s Robotic Surgery Center, told the press that:

“We are investigating whether surgical trainees should warm up prior to surgery, and we’re including experienced surgeons in our study.”

“We might discover that everyone should warm up before operating,” he added, commenting that such a revelation would lead to a “complete paradigm shift in surgical preparation”.

To study the effect of warm up on surgeon performance, the researchers intend to use a virtual reality simulator based on the da Vinci surgical robot, which surgeons use to carry out complex minimally invasive surgery such as prostatectomies.

The surgeon controls the robot, which is made by Intuitive Surgical and sports several arms holding various tools (eg. scalpel, scissors, camera, cauterizer), using two hand-held controllers and two foot pedals. While the surgeon is doing this he or she also sees 3-D views of what is happening, a great advantage over the 2-D views with traditional laparoscopic surgery.

Lendvay and colleagues will develop software and hardware, and a “proficiency-based curriculum with measurable outcomes”. They intend to recruit medical students, surgical residents and faculty members to test the curriculum over an 18-month period which ends around March 2011.

The University of Washington (UW) has tackled the subject of surgeon warm-ups already, in an earlier study published in February 2009, UW researchers teamed up with colleagues from Arizona State University and found that warming up did make a difference to surgeon performance, as Lendvay explained:

“Even experienced surgeons derived benefit from the warm-up and there was an error reduction in surgical skills.”

In that study, the researchers found that a warm up comprising 15 to 20 minutes of simple surgical exercises involving both psychomotor and cognitive skills before an operation raised surgeons’ alertness to a higher level for surgical procedures and also helped fatigued surgeons perform better.

Lendvay said findings from the new study could be useful not only for general surgical training, but also for designing ways to keep surgeons deployed by the military overseas up to date so they can carry on practicing when they return to the US.

“These surgeons have ebbs and flows in the number of patients they’ll see and experience some down time,” said Lendvay.

“It’s likely that they would benefit from virtual reality surgical task training,” he added.

Seattle Children’s Robotic Surgery Center uses the da Vinci robotic system to carry out minimally invasive robot assisted laparoscopy (RAL).

During RAL the child’s stomach is filled with carbon dioxide (CO2) which creates a space or a bubble in which to do the surgery. Then the surgeon makes three small keyhole incisions through which the robot arms insert a video camera and surgical instruments.

Source
MedicalNewsToday

Pleural Mesothelioma

Other name: Malignant Mesothelioma

Mesothelioma is a form of cancer that is almost always caused by exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body’s internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the heart) or tunica vaginalis.

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma. Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers.

Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Contents

Signs and Symptoms
Causes
Diagnosis
Pathogenesis/Pathophysiology
Prevention
Treatment
Complications
References

Signs and Symptoms

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Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

• Chest wall pain
• Pleural effusion, or fluid surrounding the lung
• Shortness of breath
• Fatigue or anemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

• Abdominal pain
• Ascites, or an abnormal buildup of fluid in the abdomen
• A mass in the abdomen
• Problems with bowel function
• Weight loss

In severe cases of the disease, the following signs and symptoms may be present:

• Blood clots in the veins, which may cause thrombophlebitis
• Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• Jaundice, or yellowing of the eyes and skin
• Low blood sugar level
• Pleural effusion
• Pulmonary emboli, or blood clots in the arteries of the lungs
• Severe ascites

Causes

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Mesothelioma is caused by asbestos exposure which occurs when fibers are inhaled or ingested into the body and become lodged in body cavities, causing inflammation or infection. Asbestos is a naturally-occurring fibrous substance that was widely used in the 20th century in a number of different industries. When the public became aware of the hazards associated with the mineral, warnings were issued in the mid-1970s and use of the product began to decline.

Diagnosis

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If the signs and symptoms that indicate mesothelioma are present, the doctor will conduct a physical exam to check for any lumps or other unusual signs. The doctor may order imaging scans, such as a chest X-ray or a computerized tomography (CT) scan of the chest or abdomen, to look for abnormalities.

It’s not uncommon for mesothelioma to be misdiagnosed initially because mesothelioma is rare, and its signs and symptoms aren’t specific. The doctor will likely rule out other more common conditions before considering mesothelioma.

Biopsy

Biopsy, a procedure to remove a small portion of tissue for laboratory examination, is the only way to determine whether a patient has mesothelioma. Depending on what area of the body is affected, the doctor selects the right biopsy procedure for the patient. Options include:

• Fine-needle aspiration. The doctor removes fluid or a piece of tissue with a small needle inserted into the chest or abdomen.
• Thoracoscopy. Thoracoscopy allows the surgeon to see inside the chest. In this procedure, the surgeon makes one or more small incisions between the ribs. A tube with a tiny video camera is then inserted into the chest cavity — a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow the surgeon to cut away tissue for testing.
• Laparoscopy. Laparoscopy allows the surgeon to see inside the abdomen. Using one or more small incisions into the abdomen, the surgeon inserts a tiny camera and special surgical tools to obtain a small piece of tissue for examination.
• Thoracotomy. Thoracotomy is a surgery to open the chest between the ribs to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
• Laparotomy. Laparotomy is surgery to open the abdomen to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.

The tissue sample is analyzed under a microscope to see whether the abnormal tissue is mesothelioma and what types of cells are involved. The type of mesothelioma determines the treatment plan.

Staging

Once mesothelioma is diagnosed, the doctor orders other tests to determine the extent, or stage, of the cancer. Imaging tests that may help determine the stage of the cancer include:

• Chest X-ray
• CT scans of the chest and abdomen
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)

Once the extent of pleural mesothelioma is determined, a stage is assigned. Formal stages aren’t available for other types of mesothelioma because these types are rare and aren’t well studied. The stages of pleural mesothelioma are:

• I. Stage I – pleural mesothelioma is considered localized cancer, meaning it’s limited to one portion of the lining of the chest.
• II. Stage II – mesothelioma may have spread beyond the lining of the chest to the diaphragm or to a lung.
• III. Stage III – mesothelioma may have spread to other structures within the chest and may involve nearby lymph nodes.
• IV. Stage IV – mesothelioma is an advanced cancer that has spread to distant areas (metastasized).

Pathogenesis/Pathophysiology

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The mesothelium consists of a single layer of flattened cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.

Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than “feathery fibers” (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs.

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

• Neurofibromatosis type 2 at 22q12
• P16INK4A
• P14ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

• Inactivation of tumor suppressor genes
• Activation of oncogenes
• Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
• Activation of DNA repair enzymes, which may be prone to error
• Activation of telomerase
• Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favor the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known as clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defenses.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibers.

Prevention

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Avoid asbestos exposure, wear protective work clothing.

Treatment

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Treatment of malignant mesothelioma using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved an average of 74.6 percent success rate in extending the patient’s life span by five years or more (this percentage may increase or decrease depending on date of discovery / stage of malignant development – Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself, which has proved only by 16.3 percent likely to extend a patient’s life span by five years or more. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Surgery

Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women’s Hospital in Boston. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomized and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name “Alimta” chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive “curative” surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted, but non-randomized data have shown lower response rates and high rates of hematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma, after a research conducted by a nationwide study of Duke University concluded an almost 50 point increase in remission rates.

Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

Complications

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The list of complications that have been mentioned in various sources for Mesothelioma includes:

• Respiratory failure
• Death
• The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body
• Pleural effusion
• Hypertrophic pulmonary osteo-arthropathy
• Hypoglycemia
• Chest pain
• Ascites
• Pleural thickening
• Digital clubbing

Advance Search

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References

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1. Ashrafian H, Athanasiou T, Yap J, DeSouza AC. Two-chamber intracardiac mesothelioma. Asian Cardiovasc Thorac Ann. 2005 Jun;13(2):184-6.

2. Eastbourne Today. “Woman’s death from asbestos”. Retrieved 2008-10-28.

3. Muscat JE, Wynder EL (May 1991). “Cigarette smoking, asbestos exposure, and malignant mesothelioma”. Cancer Res. 51 (9): 2263–7. PMID 2015590.

4. “Mayoclinic, Mesothelioma”

5. Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT (2002). “Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases”. Ultrastruct Pathol 26 (2): 55–65. doi:10.1080/01913120252959227. PMID 12036093.

6. Sugarbaker DJ, Flores RM, Jaklitsch MT et al. (January 1999). “Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients”. J Thorac Cardiovasc Surg 117 (1): 54–63; discussion 63–5. doi:10.1016/S0022-5223(99)70469-1. PMID 9869758.

7. Vogelzang N, Rusthoven J, Symanowski J, Denham C, Kaukel E, Ruffie P, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003 Jul;21(14):2636-44

8. Santoro A, O’Brien M, Stahel R, Nackaerts K, Baas P, Karthaus M, et al. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaïve patients with malignant pleural mesothelioma: results of the International Expanded Access Program. J Thorac Oncol. 2008 Jul;3(7):756-63.

9. Sugarbaker PH, Welch LS, Mohamed F, Glehen O (July 2003). “A review of peritoneal mesothelioma at the Washington Cancer Institute”. Surg Oncol Clin N Am 12 (3): 605–21, xi. doi:10.1016/S1055-3207(03)00045-0. PMID 14567020.
Online manual: Management of Peritoneal Surface Malignancy.

Nursing Resource.com does keep important nursing notes in handy. We keep these notes for future references. The following have been submitted by our community.

Blood Chemistry Test (Chem 7) Normal Values
Drip Rate Formulas
Over The Counter Medicines
Test Taking Strategies (PNLE)
Vital Signs: Normal Ranges for Children
Vital Signs: Normal Ranges for Adults

The nurse is responsible for maintaining the proper flow rate while assuring the comfort and safety of the patient. The physician prescribes the flow rate. He indicates the amount of solution to be infused within a specified period of time. The rate is then determined on the basis of drops of solution to be infused every minute. This is called the DRIP RATE.

The drop factor, or drops per milliliter of solution is determined by the size of the opening in the infusion apparatus. It varies with the company producing the product. Most health agencies use the products of a single company. The most common drop factor are 10, 15, 20, and 60 drops per milliliter. Sixty drops milliliter is used most often when small fluid volumes are important such as with infants and small children. Adapters are also available that may be added to common infusion tubings to reduce the size of the drops.

A method for determining flow rate for an intravenous infusion is given below:

Legend:

gtts – drops
min – minute
hr – hour
ml – milliliter

To get the amount to infuse each hour

Formula:

Example:

A physician prescribes 1000 ml of solution to be infused in a 10-hour period. Using the above formula, determine the amount to infuse each hour as follows:

To get the amount to infuse each minute

Example:

The drop factor is 15 and the amount of solution to be infused each hour is 100. Using the above formula, determine the number of drops to infuse each minute as follows:

To get the number of mins/hrs to complete an infusion

Formula:

Example:

You have 500 ml of solution with a drip rate of 20 gtts/min, and calibrated with a  drop factor of 15 gtts/ml. Using the above formula, determine the number of hours it will take for the infusion to run out as follows:

Now you got the number of minutes it will take for the infusion to complete. To get the number of hours:

External Links

Drip Rate Calculator
IV Infusion Time Calculator

Four new studies published in a leading journal this week link exercise with healthy aging, either through reduced risk or slower progression of several age-related conditions or through improvements in overall health in older age, and detail associations between physical activity and cognitive function, bone density and overall health.

All four studies, and an accompanying editorial commentary appear in the 25 January issue of the Archives of Internal Medicine.

In the accompanying editorial, Drs. Jeff Williamson and Marco Pahor, of the University of Florida, point out that previous studies have linked exercise to beneficial effects on a range of conditions and diseases, including obesity, diabetes, heart disease, cancer, lung disease, arthritis, falls and fractures, that can hamper older people’s ability to get on with their day to day tasks and lead independent lives.

They write:

“Regular physical activity has also been associated with greater longevity as well as reduced risk of physical disability and dependence, the most important health outcome, even more than death, for most older people.”

And now, they suggest, these four new studies advance the field and help us better understand the “full range of important aging-related outcomes for which exercise has a clinically relevant impact”.

Exercise in Middle Age Linked to Better Health in Later Life

In the first of the four studies, Dr. Qi Sun, of the Harvard School of Public Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues looked at health data from 13,535 participants taking part in the Nurses’ Health Study.

They found that among women aged 70 and over, those who engaged in regular physical activity in their middle age were more likely to show signs of better overall health.

The women completed questionnaires about their physical activity in 1986, when their average age was 60.

When the researchers looked at data on health outcomes in those women that survived to age 70 and over from 1995 to 2001, they found that those who had reported higher levels physical activity in their middle age were less likely to have undergone heart surgery, have chronic diseases, or any physical, cognitive or mental impairments.

The researchers wrote that they also found:

“Increasing energy expenditure from walking was associated with a similar elevation in odds of successful survival.”

They concluded that as the US population is a rapidly aging one and nearly 25 per cent of Americans do not pursue leisure time activities:

“Our findings appear to support federal guidelines regarding physical activity to promote health among older people and further emphasize the potential of activity to enhance overall health and well-being with aging.”

They said people might be more motivated to pursue physical activities if they thought it would increase their chance of being fit and well in old age rather than just extending their lifespan.

Resistance Training Linked to Improved Cognitive Skills in Older Women

In the second of the four studies, Dr. Teresa Liu-Ambrose, of Vancouver Coastal Health Research Institute and University of British Columbia, Vancouver, Canada, and colleagues, enrolled 155 women aged 65 to 75 and randomly assigned them to one of three groups that undertook to follow a particular exercise pattern for a year.

One group of 54 participants did resistance training once a week, another group of 52 did it twice a week, and a third group of 49, the control group, didn’t do resistance training: they took part in twice-weekly sessions of balance and tone training.

The results showed that after following their exercise program for a year, compared to those in the balance and tone group, the women in both resistance training groups improved their performance on the Stroop test, a cognitive test of selective attention and conflict resolution.

Liu-Ambrose and colleagues also wrote that:

“Task performance improved by 12.6 per cent and 10.9 per cent in the once-weekly and twice-weekly resistance training groups, respectively; it deteriorated by 0.5 per cent in the balance and tone group.”

The women in the resistance training groups also improved muscular function.

The authors concluded that:

“This has important clinical implications because cognitive impairment is a major health problem that currently lacks a clearly effective pharmaceutical therapy and because resistance training is not widely adopted by seniors.”

“The doses of resistance training we used in this study fall within those recommended by the 2008 Physical Activity Guidelines for seniors,” they added.

Exercise May Be Linked to Reduced Cognitive Impairment in Older Adults

In the third of the four studies linking exercise to healthier aging, Dr. Thorleif Etgen of the Technische Universität München, Munich, and Klinikum Traunstein, Germany, and colleagues who followed a group of older adults for two years, found that moderate or high physical activity appeared to be linked with a lower risk of developing cognitive impairment.

The participants, who were older than 55 years, enrolled in a community-based prospective cohort study in southern Bavaria, Germany between 2001 and 2003 and were followed for 2 years. They gave data about their physical activity level and underwent tests of cognitive function (the 6-item Cognitive Impairment Test). The main outcome measure was the level of cognitive impairment after the 2 years of follow up.

The results showed that at the start of the study, 418 (10.7 per cent) of the participants had cognitive impairment, leaving 3,485 unimpaired.

After 2 years, 207 (5.9 per cent) of the unimpaired participants developed cognitive impairment.

When they analyzed the data on these additional 207, the researchers found that compared with those who did no physical activity, those who reported moderate (exercising less than 3 times a week) or high (3 times a week or more) levels of physical activity at the start of the study (baseline) “showed a significantly reduced risk of incident cognitive impairment after 2 years”.

“The incidence of new cognitive impairment among participants with no, moderate and high activity at baseline was 13.9 per cent, 6.7 per cent and 5.1 per cent, respectively,” they wrote.

The researchers concluded that further studies should be done to assess how much and what types of exercise might prevent or delay cognitive impairment and to what extent.

Exercise Linked to Denser Bones and Lower Risk of Falls in Older Women

For the fourth study, which ran from May 2005 to July 2008, Dr. Wolfgang Kemmler and colleagues at Freidrich-Alexander University of Erlangen- Nuremberg, Erlangen, Germany, recruited and randomly assigned 246 women aged 65 and over either to to follow an exercise program (the exercise group) or a wellness program (the control group) for 18 months.

They found that compared to the control group, the women in the exercise group appeared to have denser bones and a reduced risk of falls, but not a reduced risk of cardiovascular disease.

The exercise group followed a multipurpose 4 days per week exercise program that emphasized exercise intensity, while the controls followed a general wellness program that focused on well-being with a low intensity and low frequency program.

The main outcome measures were bone mineral density (BMD), number of falls, risk of coronary heart disease (the Framingham CHD Risk Calculator, which takes into account cholesterol level, blood pressure and presence of diabetes), and health care costs.

The results showed that among the 227 women who completed the study, the 115 in the exercise group had higher bone mineral density in the spine and hip and a 66 per cent reduced rate of falls.

Also, women in the control group were twice as likely to have fractures due to falls compared to those in the exercise group (12 versus 6), but the 10-year risk of cardiovascular disease went down in both groups with no difference between them.

There were no significant differences in direct health care costs per participant between the two groups.

The researchers concluded that:

“Compared with a general wellness program, our 18-month exercise program significantly improved BMD and fall risk, but not predicted CHD risk, in elderly women. This benefit occurred at no increase in direct costs.”

“Because this training regimen can be easily adopted by other institutions and health care providers, a broad implementation of this program is feasible,” they wrote.

Source
MedicalNewsToday

A new study from the US showed that two popular weight loss methods, one using the obesity treatment weight-loss pill orlistat plus a low-fat diet and another just based on a low carb diet were equally effective at helping people lose significant amounts of weight, but in a surprising twist found that that the low carb diet was much better at helping them lower blood pressure.

Researchers from the Veterans Affairs (VA) Medical Center and Duke University Medical Center, both in Durham, North Carolina, reported their findings in a study published online on 25 January in the Archives of Internal Medicine. The Department of Veteran Affairs paid for the research.

Lead author Dr. William S. Yancy Jr, an associate professor of medicine at Duke, said their findings send an important message to people with high blood pressure who are trying to lose weight:

“If people have high blood pressure and a weight problem, a low-carbohydrate diet might be a better option than a weight loss medication,” said Yancy, who is also a staff physician at the VA center in Durham where the study was conducted.

“It’s important to know you can try a diet instead of medication and get the same weight loss results with fewer costs and potentially fewer side effects,” he explained.

Previous research had already shown that both diets: prescription-strength orlistat (Xenical from Roche) combined with a low-fat diet, and a low-carb diet, were effective for weight loss.

But no study had pitched them head to head before, which the researchers said was a significant oversight since orlistat is now available over the counter as Alli, from GlaxoSmithKline. Plus, there is scarcely any evidence-based information to help overweight patients with chronic health issues, they added.

Yancy said their year-long study was particularly interesting because the 146 overweight participants had a range of health problems familiar to people with obesity: diabetes, high blood pressure, high cholesterol and arthritis.

This was unusual because most people who take part in weight loss studies are generally in good health and don’t have these problems, “in fact they are often excluded if they have,” said Yancy.

The results of the study showed that the average weight loss for participants in both groups (the orlistat with low-fat diet group and the low carb diet group) was nearly 10 per cent of their body weight.

Yancy said that not many studies reach that level of weight loss. He reckons this study managed it because the participants were offered group counseling for 48 weeks.

He also said that the participants tolerated orlistat better than he expected. The drug often has gastro-intestinal side effects that can be offputting (oily and loose stools with excessive flatulence due to unabsorbed fat reaching the large intestine), but these can be minimized by following a low fat diet, said Yancy.

“We counseled people on orlistat in our study fairly extensively about the low-fat diet,” he explained.

The two diets were also equally effective at improving cholesterol and glucose levels, said the researchers, but the surprise came when they looked at the results for blood pressure.

Systolic blood pressure dropped considerably in the group following the low-carb diet compared to the orlistat plus low-fat diet group.

Plus, almost half (47 per cent) of the participants following the low carb diet either reduced their blood pressure medication or were able to come off it altogether, while in the orlistat plus low-fat diet group the result was much less dramatic: only 21 per cent experienced a reduction in blood pressure medication.

Yancy said he expected both methods to result in significant weight loss, but he and his team were surprised to see such a dramatic improvement in blood pressure in the low-carb as opposed to the orlistat, low-fat diet group. He said he doesn’t know what the underlying mechanism could be: it’s not clear why or how it happened.

Perhaps the low-carb diet has an added effect, said Yancy, and there should be more studies to see what it might be.

Yancy said this study adds to the growing evidence that many diets are effective for losing weight, but the biggest impact appears to be in counseling patients to help them understand their options and how to follow them.

He said finding new ways to help people maintain their new lifestyle was even more important.

Source:
MedicalNewsToday