Never ignore blood in sputum
Dr S.K. Jindal

It was almost two centuries ago when John Keats, the famous English poet, woke up one morning, coughed and noticed some blood in his phlegm. He wrote: “That is blood from my mouth .... I know the colour of that blood — it is artificial blood — I cannot be deceived in that colour — that drop of blood is my death warrant. I must die.” The symptom since then is identified with the diagnosis of tuberculosis and is greatly feared.

The presence of blood in the sputum, called haemoptysis, is always a cause for worry. In modern times, it raises suspicions not only about tuberculosis but also other serious problems such as cancer. While bleeding should never be ignored, it is not necessarily a result of a dangerous disease.

The presence of scanty, fresh red-coloured blood mostly points to the mouth or the throat as the source. Bleeding commonly occurs from bad, carious teeth which can often be persistent and chronic if the appropriate treatment is not taken. Similarly, fresh blood spots can also be seen after a forceful act of sneezing or coughing, especially during or after an episode of common cold or upper respiratory tract catarrh. An apthous ulcer in the mouth or throat may also bleed off and on and pose a diagnosis problem.

An acute occurrence of bleeding may occur in cases of pneumonias or acute bronchitis. Such episodes are also usually temporary, and subside after the treatment of the underlying cause. Nonetheless, they do point to the need for an active management plan. Occurrence of bleeding in a middle-aged individual, especially in a smoker, should always be viewed seriously. It is important to rule out cancer of the respiratory tract in such cases.

The presence of larger amounts of altered blood points to the lungs as the source of bleeding. Tuberculosis and other cavitary diseases of the lungs should be suspected. Occasionally, bleeding from the stomach, usually in the vomited material induced by a bout of cough, can be confused with bleeding from the respiratory system. The two can often be distinguished by a careful study of the person’s history and from the presence of food particles in the vomited blood. This certainly requires a thorough medical check-up.

There are several other causes of haemoptysis, including heart problems, bleeding disorders and vascular illnesses. It is essentially for the physician to localise the site and look for the appropriate illness. Of particular importance to mention is the relatively common occurrence of a clot in the pulmonary artery which may present with sudden haemoptysis, breathlessness and chest pain. This condition may prove to be serious, sometimes a cause for sudden death, especially in bed-ridden patients following fractures, surgical operations or other chronic diseases.

What should I do in the case of a repeat massive bleed?” This is an important question frequently posed by a patient with recurrent bleeding episodes. Most of these patients are those in whom the diagnoses are already established, yet the treatment remains elusive. The important issue with reference to haemoptysis is to correctly diagnose the underlying cause which determines the treatment in most cases. Unfortunately, there is no miracle drug which can control haemoptysis. Most of the drugs such as the antibiotics, anti-tubercular drugs or other agents take time before they are able to control the underlying infection, if any. A massive haemoptysis may also necessitate the need for blood replacement.

Episodes of recurrent haemoptysis in patients with chronic problems, especially in the presence of lung destruction, remain a cause for concern. Surgical options are usually limited, but should be explored. Surgical resection is feasible only in the case of a localised disease in an otherwise fit patient. Temporary relief can sometimes be offered by blocking the bleeding vessels through interventional imaging techniques. It is mostly the conservative approach of “supportive therapy” which is often employed.

Blood in the sputum is not a disease by itself. It is a symptom, a signal for an individual to be careful and seek a medical consultation. Some of the simple diagnoses can be excluded with little difficulty. More tests are required in other patients. A sputum examination for finding out the presence of tubercle bacilli is recommended for all such patients. Such a facility is easily available at all DOTS centres established under the Revised National Tuberculosis Control Programme. It should also be considered as a warning to quit smoking and adopt a healthy lifestyle.

The writer is Professor & Head, Department of Pulmonary Medicine, PGI, Chandigarh.

New discovery brings anti-ageing pill a step closer

London: Scientists from the University of Wisconsin-Madison have discovered a key anti-ageing enzyme that stops our cells from decaying. The finding has put them a step closer to creating an anti-ageing drug.

It has long been known that reducing calorie intake can dramatically slow the process of ageing and improve health in later life.

Now, researchers have identified a key enzyme called Sirt3, which causes this dramatic effect in cell molecules.

‘We’re getting closer and closer to a good understanding of how caloric restriction works. This study is the first direct proof for a mechanism underlying the anti-aging effects we observe under caloric restriction,” The Daily Mail quoted lead scientist Professor Tomas Prolla as saying.

The discovery not only helps explain the cascade of events that contributes to ageing, but also provides a basis for devising drugs that could extend the average life span.

The team studied mice with age-related hearing loss, which is linked to free radical damage to the cells in the inner ear.

They focused on the mitochondria — structures inside cells that produce energy and are the sources of highly reactive forms of oxygen known as free radicals, which damage cells and promote the effects of aging.

The researchers found that under reduced-calorie conditions levels of Sirt3 increased altering metabolism and resulting in fewer free radicals produced by mitochondria.

Signs of free radical damage are skin that is leathery, or wrinkled and sagging, and stiffness in the joints.

Smoking, sunbathing, fried food, infections and stress can all produce excess free radicals. However, green leafy vegetables and whole grain bread contain antioxidants that can neutralise them.

“This is the strongest and most direct link that caloric restriction acts through mitochondria,” Prolla said.

Sirt3 is one of seven enzymes in the sirtuin family that appear to have a wide-ranging impact on cell fate and physiology.

However, the new study provides “the first clear evidence that sirtuins have anti-aging effects in mammals.”

Understanding the molecular basis of how the sirtuin enzymes work may ultimately lead to the development of drugs that activate the pathways of enzymes like Sirt3 to slow down the process of ageing.

The study has been published in the journal Cell. — ANI

Elderly can blame low sodium for fractures, falls

Washington: A new study has shown that older adults with even mildly decreased levels of sodium in the blood (hyponatremia) experience increased rates of fractures and falls. Falls are a serious health problem for the elderly and account for about 50 per cent of deaths due to injury in the elderly. “Screening for a low sodium concentration in the blood, and treating it when present, may be a new strategy to prevent fractures,” comments Ewout J. Hoorn, (Erasmus Medical Center, Rotterdam, the Netherlands).

However, hyponatremia does not appear to affect the risk of osteoporosis, as defined by low bone mineral testing, so more research is needed to understand the link between sodium levels and fracture risk. The study included more than 5,200 Dutch adults over age 55, all with initial information on sodium levels and six-year follow-up data on fractures and falls. “A number of recent studies suggested a relationship between hyponatremia, falls, osteoporosis, and fractures,” Hoorn explains. — AN