A simple blood test can accurately identify patients at very low risk for heart attack, say, researchers. Almost two-thirds of people who arrive in an emergency room complaining of chest pain and fearing cardiac arrest might be safely discharged, the results of the new study suggest.

“Implementation of this approach would reduce avoidable hospital admission and have major benefits for both patients and health-care providers,” wrote the authors sponsored by the University of Edinburgh and funded in part by the British Heart Foundation.

When patients complain of chest pain, doctors make a diagnosis of myocardial infarction (heart attack) based on evidence of heart muscle damage. Specifically, they use a blood test that measures a protein (or chemical) known as troponin, which is released into the blood by damaged heart muscles. A high troponin level or even slight elevation can indicate injury to the heart, according to the American Association for Clinical Chemistry.

When levels of troponin are unusually high or if a series of tests performed over several hours show elevated levels, doctors take this as proof that a patient has had a heart attack or some other cardiac event.

Commonly, emergency room doctors perform the test on someone complaining of chest pain when they are first admitted and then again 12 hours later.

Recently, a more sensitive troponin test, which is capable of measuring finer levels of troponin, was introduced. Importantly, the new test needs to be performed only once. The new study, then, investigated whether the more sensitive test might more accurately diagnose and predict a heart attack.

Conducting the research at hospitals in Scotland and the United States, the science team measured blood troponin concentrations using the high-sensitivity test for 6,304 patients with suspected heart attacks.

“Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from the hospital,” wrote the researchers, who say the high sensitivity test was 99.6 percent accurate.

Symptoms of a heart attack include chest discomfort or pain (that often feels like squeezing), upper body pain, stomach pain, shortness of breath, anxiety, lightheadedness, sweating, and nausea and vomiting. According to the American Heart Association, women most commonly experience chest pain or discomfort just like men, but they are more likely than men to experience other symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Source: Shah ASV, Anand A, Sandoval Y, et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. The Lancet. 2015.

Susan Scutti / Medical Daily

Normally, grenades are bad for your health. They explode, spreading shrapnel and other incendiaries into a thousand different directions, with only one purpose: causing maximum harm to anyone unlucky enough to be within the blasts’ radius. Fortunately, the grenade we’re talking about today does more good than bad, as it targets and kills cancer tumors.

Researchers from the University of Manchester will present two studies at the National Cancer Research Institute (NCRI) Cancer Conference in Liverpool that describes cancer drug-packed “grenades” with heat-sensitive triggers that allow for the direct treatment of cancerous tumors. The “grenades” are actually liposomes? small, bubble-like structures built out of cell membrane? and they’re used as packages to deliver drugs into the cancer cells. The challenge the researchers faced was being able to target tumors with the cancer drug-carrying liposomes, while also keeping healthy tissue intact.

The two studies show how the team managed to clear this hurdle by giving the liposomes heat-activated triggers. Testing the liposomes in a cell culture and lab mice, the team found that by slightly heating the tumors with warm water baths and heating pads, it was able to pinpoint the exact place where cancer resided? the “grenades” could then detonate and release the drugs.

“Temperature-sensitive liposomes have the potential to travel safely around the body while carrying your cancer drug of choice,” said Kostas Kostarelos, study author and professor of nanomedicine at the University of Manchester, in a press release. “Once they reach a ‘hotspot’ of warmed-up cancer cells, the pin is effectively pulled and the drugs are released. This allows us to more effectively transport drugs to tumors, and should reduce collateral damage to healthy cells.”

The researchers set the thermal triggers of the liposomes to 42 degrees Celsius (107 degrees Fahrenheit), which is slightly higher than normal body temperature. But, according to Kostarelos, “this work has only been done in the lab so far; [however], there are a number of ways we could potentially heat cancer cells in patients? depending on the tumor type? some of which are already in clinical use.”

These studies open up a “range of new treatment avenues,” said Professor Charles Swanton, chair of the 2015 NCRI Cancer Conference, in the press release. “This is still early work, but these liposomes could be an effective way of targeting treatment toward cancer cells while leaving healthy cells unharmed.”

Source: Kostarelos K, et al. National Cancer Research Institute Cancer Conference. 2015.

By Steve Smith / Medical Daily

Many of us fear to go to the dentist on the off chance the dentist will need to drill our teeth. However, a dental care technique devised by researchers at the University of Syndey could stop, reverse, and prevent tooth decay without the traditional “fill and drill” approach.

“It’s unnecessary for patients to have fillings because they’re not required in many cases of dental decay,” said Wendell Evans, lead author of the study and associate professor at the university, in the news release.

It was once believed that tooth decay was a rapidly progressive disease and the best way to manage it was to identify early decay and remove the tooth surface from breaking into cavities. After removing the decay, the affected tooth would then be restored with filling material, a process which would come to be known as “filling and drilling.” However, Evans explained, it takes four to eight years before tooth decay reaches the inner layer of a tooth. While tooth decay begins to become noticeable in the outer layer of the tooth or the enamel, the time window is sufficient to offer an alternative preventive treatment for the patient.

Enter Evans and his colleagues. They devised a process known as Caries Management System (CMS) technique, a set of protocols which cover the assessment of decay risk, the interpretation of dental X-rays, and specific treatment of early decay (decay that is not yet a cavity). The treatment involves four aspects: application of high concentration fluoride varnish to sites of early decay; attention to home tooth brushing skills; restriction of between-meal snacks and beverages containing added sugar; and risk-specific monitoring. The CMS technique was proven successful when first tested on high-risk patients at Westmead Hospital in Sydney.

“It showed that early decay could be stopped and reversed and that the need for drilling and filling was reduced dramatically. A tooth should only be drilled and filled where an actual hole in the tooth (cavity) is already evident,” Evans said.

To observe the effects of this technique on tooth decay, researchers assigned 19 patients at high risk for tooth decay to an experiment or control group for three years in general dental practices in New South Wales and Australian Capital Territory. Follow-up studies were conducted at two and four years after the clinical trial. After seven years, tooth decay reduced dramatically by 30 to 50 percent in patients in the CMS program compared to the control group.

However, the researchers stress there needs to be open communication between dentists and their patients to reduce decay risk and the need for fillings. “…Patients play an important role in their treatment. This treatment will need a partnership between dentists and patients to be most successful,” Evans said.

Patients can make the most of CMS by paying attention to their tooth-brushing skills at home and restricting between-meal snacks and beverages that contain added sugar. For example, when a tooth is exposed to acid frequently in foods or drinks that contain sugar and starches the acid build-up will cause the enamel to lose minerals, according to the National Institute of Dental and Craniofacial Research. A white spot can appear where minerals have been lost, which is a sign of tooth decay. The enamel can repair itself by using minerals from saliva, and fluoride from toothpaste or other sources.

The CMS technique could help the 92 percent of adults with tooth decay in their permanent teeth in the U.S. This suggests it is imperative to start adopting more oral care practices at home. The prevalence of untreated decay in permanent teeth is highest among adults between the ages of 20 to 34 years a population that has most of their teeth.

When it comes to tooth decay, prevention may be the best idea.

Source: Evans W et al. “No-drill” dentistry stops tooth decay. Community Dentistry and Oral Epidemiology. 2015.

By Lizette Borreli / Medical Daily