A trio of indicators that suggest a higher risk of death COVID-19 patients

In Wuhan, China, research shows 14-19% of infected patients became severely sick. Among those critically ill cases, the death rate was higher than 60%.

To identify commonalities between these severe cases, ther esearchers analysed blood samples taken repeatedly from 485 patients at Tongji Hospital in Wuhan, China, between Januar10 and February 18. They tested for  myriad kidney, heart, and blood-clotting issues, noted whether those patients had survived or died, then used machine-learning algorithms to look for biological patterns.

The results found that the following indicators can predict whether a patient had a higher risk of death than other infected people:

1) High levels of the enzyme lactic dehydrogenase (LDH). This is associated with lung damage and the type of tissue breakdown that happens during pneumonia.

2) Lymphopenia, the terms for low levels of lymphocytes---white blood cells that defend the body against invading pathogens.

3) An increase in high-sensitivity C-reactive proteins, or hs-CRP for short. This indicates inflammation in the lungs.

Using those indicators, the computer model could predict what happened to the hospital patients 10 days  in advance of their clinical outcomes.

The 3 key features, LDH, lymphocytes and hs-CRP, can be easily collected in any hospital, the researchers wrote in the study. In crowded hospitals, and with shortages of medical resources, this simple model can help to quickly prioritize patients, especially during a pandemic when limited healthcare resources have to be allocated.

A coronavirus ' risk score'.

Another study published this week took a similar approach, pinpointing 10 biomarkers that can help doctors assess individual patients' risk levels. That research, published in the Journal of the American Medical Association on Tuesday, suggested using these markers to determine the likelihood that a hospitalised cOVID-19 patient will become critically ill-- admitted to an intensive-care unit or put on a ventilator-- or die.

The researchers retrospectively examined medical records from 1,590 patients who were treated in 575 hospitals across China between November 21, 2019 and January 31.

Two of those biomarkers overlap with those suggested in the Nature study: high levels of LDH and a high neutrophil-to-lymphocyte ratio ( which is associated with lower levels of lymphocytes).

The other eight risk predictors include a history of cancer, high number of pre-existing medical conditions, older age, shortness of breath, coughing up blood, unconsciousness, abnormal chest x-rays, and high levels of bilirubin ( a substance in the blood that, in elevated amounts, indicates liver damage).

The researchers used those 10 indicators to develop an online coronavirus risk " calculator" that could help predict which hospitalised COVID-19 patients will become critically ill.

That prediction tool could enable doctors and healthcare workers optimise hospital resources, the study authors wrote.

If the patient's estimated risk for critical illness is low, the clinician may choose to monitor, whereas high-risk estimates might support aggressive treatment or admission to the ICU, they said.

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6 Little-Known Dangers of Restricting Sodium Too Much

Sodium is an important electrolyte and main component of table salt.

Too much sodium has been linked to high blood pressure, and health organizations recommend that you limit your intake .

Most current guidelines recommend eating less than 2,300 mg per day. Some even go as low as 1,500 mg per day.

However, even though too much sodium causes problems, eating too little can be just as unhealthy.

Here are 6 little-known dangers of restricting sodium too much.

1. May increase in insulin resistance
A few studies have linked low sodium diets to increased insulin resistance .

Insulin resistance is when your body’s cells don’t respond well to signals from the hormone insulin, leading to higher insulin and blood sugar levels.

Insulin resistance is believed to be a major driver of many serious diseases, including type 2 diabetes and heart disease .

One study involving 152 healthy people found that insulin resistance increased after only 7 days on a low sodium diet .

Yet, not all studies agree. Some have found no effect, or even a decrease in insulin resistance .

However, these studies varied in length, study population, and degree of salt restriction, which may explain the inconsistent results.

    summary

    Low sodium diets have been associated with increased insulin resistance, a condition that causes higher blood sugar and insulin levels. This may lead to type 2 diabetes and other serious diseases.

2. No clear benefit for heart disease

It’s true that reducing your sodium intake can reduce your blood pressure.

However, blood pressure is only a risk factor for disease. What’s really significant is hard endpoints like heart attacks or death.

Several observational studies have looked at the effects of low sodium diets on heart attacks, strokes, and the risk of death .

One study found that less than 3,000 mg of sodium per day is linked to an increased risk of dying from heart disease, including heart attacks and strokes .

Disturbingly, another study reported a higher risk of dying from heart disease at the lower sodium levels that many guidelines currently recommend .

However, other studies have reported conflicting results, so this matter is far from settled .

In a 2011 review, reducing sodium didn’t reduce the risk of dying from heart attacks or strokes, and it increased the risk of death from heart failure .

    summary

    Although the evidence is mixed, some observational studies show that low salt diets are linked to an increased risk of death from heart attacks or strokes. Controlled trials show no clear benefit.

3. Increased risk of death from heart failure

Heart failure is when the heart is not able to pump enough blood around the body to meet its needs for blood and oxygen.

This doesn’t mean that your heart stops working completely, but it’s still a very serious health issue.

Interestingly, low sodium diets have been linked to an increased risk of death in people with heart failure.

One review found that for people with heart failure, limiting sodium intake increased the risk of dying .

In fact, the effect was strong — people who restricted their sodium intake had a 160% higher risk of death. This is concerning, as people with heart failure are often told to limit their sodium intake.

Yet, the results were strongly influenced by only one study, so more research is needed.

    summary

    There’s some evidence that people with heart failure may have a higher risk of dying on a low sodium diet. However, more studies are needed to confirm this.

4. May raise LDL (bad) cholesterol and triglycerides

Many factors can increase the risk of heart disease, including elevated LDL (bad) cholesterol and triglycerides.

Some studies have found that low sodium diets may increase both LDL (bad) cholesterol and triglyceride levels.

In a 2003 review of studies in healthy people, low sodium diets caused a 4.6% increase in LDL (bad) cholesterol and a 5.9% increase in triglycerides .

A more recent review reported a 2.5% increase in cholesterol and a 7% increase in triglycerides .

What’s more, these studies found that salt restriction only caused minor reductions in blood pressure, on average, with a slightly stronger effect in people with high blood pressure.

    Summary

    Studies have found that limiting salt may raise LDL (bad) cholesterol and triglycerides, which are common risk factors for heart disease.

5. Increased risk of death for people with diabetes

People with diabetes have an increased risk of heart attack and stroke .

Therefore, many guidelines for those with diabetes recommend limiting salt intake .

However, some studies have found an association between low sodium intake and an increased risk of death among those with both type 1 and type 2 diabetes .

However, these were observational studies, and their results should be interpreted with caution.

    Summary

    People with type 1 and type 2 diabetes may have an increased risk of death on a low sodium diet. However, this needs to be studied further.

6. Higher risk of hyponatremia (low blood levels of sodium)

Hyponatremia is a condition characterized by low levels of sodium in the blood.

Its symptoms are similar to those caused by dehydration. In severe cases, the brain may swell, which can lead to headaches, seizures, coma, and even death .

Certain populations, like older adults, have a higher risk of hyponatremia .

That’s because older adults are more likely to have an illness or take medication that can reduce sodium levels in the blood.

Athletes, especially those who participate in long-distance endurance events, are also at a high risk of developing exercise-associated hyponatremia .

In their case, it’s usually caused by drinking too much water and failing to replace the sodium that’s lost through sweat .

    summary

    A condition called hyponatremia, or low blood sodium levels, may affect certain people like older adults and some athletes. Eating less salt raises the risk of this condition.

The bottom line

The National Academy of Medicine (NAM) recommends a sodium intake of less than 2,300 mg per day, corresponding to 5.8 grams of salt.

Studies suggest that there’s a J-shaped curve when it comes to the effects of sodium.

Too much may be harmful, but too little can also have serious consequences.

The lowest risk of health issues and death seems to be somewhere in between.

Controversially, some researchers have suggested an intake of 3,000–5,000 mg of sodium per day is considered optimal.

This exceeds the maximum daily intake recommended by NAM, but it’s similar to what the average person already eats in the United States.

This amounts to 7.5–12.5 grams of table salt per day, which equals 1.5–2.5 teaspoons per day (salt is only 40% sodium, so multiply sodium by 2.5 to find the amount of salt).

However, many people may benefit from restricted sodium intake, such as those with salt-sensitive high blood pressure .

If you have a medical condition that requires a diet low in sodium, or if your healthcare provider has advised you to limit your intake, by all means, continue to do so.

However, if you’re a healthy person trying to stay healthy, there’s no good evidence that following a low sodium diet will improve your health.

Most of the excess sodium people eat comes from processed, packaged foods — stuff you shouldn’t be eating much of anyway.

Adding some salt to your healthy foods to improve their flavor is both safe and healthy — and can make your diet much more pleasurable.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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Daytime sleepiness among the elderly may indicate cancer risk

Older people who experience daytime sleepiness even after having adequate sleep at night may be at the risk of developing new medical conditions, including diabetes, cancer and high blood pressure, says a study. The condition called hypersomnolence is defined as excessive daytime sleepiness even after having seven or more hours of sleep.

It can be debilitating for some people, affecting the way that they perform at work and in other daily activities. "Paying attention to sleepiness in older adults could help doctors predict and prevent future medical conditions," said study author Maurice Ohayon of Stanford University in California.

"Older adults and their family members may want to take a closer look at sleeping habits to understand the potential risk for developing a more serious medical condition," said Ohayon.

The study involved 10,930 people. About 34 per cent of the participants were 65 years or older.

The findings are scheduled to be presented at the American Academy of Neurology's 72nd annual meeting to be held in Toronto from April 25 to May 1.

For the study, the researchers interviewed participants over the phone two times, three years apart. In the first interview, 23 per cent of people over 65 met the criteria for excessive sleepiness.

In the second interview, 24 per cent reported excessive sleepiness. Of those, 41 per cent said the sleepiness was a chronic problem.

The study found that people who reported sleepiness in the first phone interview had a 2.3 times greater risk of developing diabetes or high blood pressure three years later than those who did not experience sleepiness.

They were also twice as likely to develop cancer.

Of the 840 people who reported sleepiness at the first interview, 52 people, or 6.2 per cent, developed diabetes compared to 74 people, or 2.9 per cent of those who were never sleepy during the day.

Also, of the 840 people who reported sleepiness, 20 people, or 2.4 per cent, developed cancer compared to 21 people, or 0.8 per cent of those who were never sleepy during the day.

People who reported daytime sleepiness during both interviews had a 2.5 times greater risk of developing heart disease. Those who reported sleepiness only in the second interview were 50 per cent more likely to also have diseases of the musculoskeletal system and connective tissue, such as arthritis, tendinitis and lupus, than those who did not have daytime sleepiness.

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Fluoroquinolones antibiotics associated with risk of heart problems

In a new study, researchers have established the link between one of the most commonly prescribed class of antibiotics and heart problems.

In a study published in the Journal of the American College of Cardiology, researchers found that current users of fluoroquinolone antibiotics, such as Ciprofloxacin or Cipro, face a 2.4 times greater risk of developing aortic and mitral regurgitation, where the blood back flows into the heart, compared to patients who take amoxicillin, a different type of antibiotic.

The greatest risk is within 30 days of use.

Some physicians favour fluoroquinolones over other antibiotics for their broad spectrum of antibacterial activity and high oral absorption, which is as effective as intravenous, or IV, treatment.

“You can send patients home with a once-a-day pill,” said Mahyar Etminan, lead author and associate professor of ophthalmology and visual sciences in the faculty of medicine at University of British Columbia.

“This class of antibiotics is very convenient, but for the majority of cases, especially community-related infections, they’re not really needed. The inappropriate prescribing may cause both antibiotic resistance as well as serious heart problems,” added Etminan.

“One of the key objectives of the Therapeutic Evaluation Unit is to evaluate different drugs and health technologies to determine whether they enhance the quality of care delivered by our programs or improve patient outcomes,” said Dr. Bruce Carleton, director of the unit and research investigator at BC Children’s Hospital, a program of PHSA.

For the study, researchers analyzed data from the U.S. Food and Drug Administration’s adverse reporting system. They also analyzed a massive private insurance health claims database in the U.S. that captures demographics, drug identification, dose prescribed and treatment duration.

Researchers identified 12,505 cases of valvular regurgitation with 125,020 case-control subjects in a random sample of more than nine million patients.

They defined current fluoroquinolone exposure as an active prescription or 30 days prior to the adverse event, recent exposure as within days 31 to 60, and past exposure as within 61 to 365 days prior to an incident. They compared fluoroquinolone use with amoxicillin and azithromycin.

The results showed that the risk of aortic and mitral regurgitation, blood backflow into the heart, is highest with current use, followed by recent use. They saw no increased risk aortic and mitral regurgitation with past use.

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High dose intake of opioid is not effective in reducing pain

A recent study has established that high dose intake of opioid is not effective in reducing pain.
The researchers' team from Central Arkansas and Minneapolis VA Health Care Systems and three universities have suggested after studying available data that patients who got their opioid dosage increased were not helped by the higher dosage as compared to those, who continued with earlier dosage.

The Veterans Affairs study looked at prescribing data of more than 50,000 VA patients taking opioids. The findings led the study authors to warn: "Clinicians should exercise extreme caution when embarking on a path of increasing opioid doses to manage non-cancer pain."

The results were published in the January 9 issue of the journal 'Pain'.

A companion study by the same team that appeared online on January 15, in addition, confirmed the increased risk of side effects from higher doses.

Lead author Dr Corey Hayes in a University of Arkansas for Medical Sciences report said: "You don't see the benefit, but you do see the risk. Our overall message is when you're thinking about increasing the dose, you need to realize the risk it brings, too."

Opioid medications relieve pain. They reduce the intensity of pain signals in the brain and affect areas of the brain controlling emotion, which diminishes the effects of pain stimuli. While opioids can help manage pain when taken correctly, they have a high risk of abuse and addiction.

Patients often receive increased doses of opioid medication because their pain may not be well-controlled on lower doses. People can also develop a tolerance to opioids over time, meaning a higher dose is needed to get the same effects. In these cases, prescribers must weigh the risks and rewards of escalating a patient's opioid dose.

Moreover, higher opioid doses can lead to a variety of side effects, such as constipation, dizziness, increased sensitivity to pain, and increased risk of substance use disorder. 

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     
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