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Study Casts Doubt on Angioplasty, Bypass for Many Heart Patients

SUNDAY, Nov. 17, 2019 — Bypass operations, angioplasty and the placement of artery-opening stents: For decades, millions of Americans have undergone these expensive, invasive procedures to help treat clogged vessels.

However, the results of a large and long-awaited clinical trial suggests that, in most cases, these procedures may not have provided any benefit over medications and lifestyle changes.

In fact, people treated with meds and healthy changes in lifestyle wound up about as healthy as those who underwent an invasive procedure to open their hardened arteries, researchers reported Saturday at the American Heart Association (AHA) annual meeting in Philadelphia.

Only a subgroup of patients who suffered from frequent angina appeared to receive any benefit from an invasive procedure, and that benefit was in their quality of life, not in lowering their odds of death or future heart problems.

“Based on the trial results to date, I as a clinician would feel comfortable advising my patient not to undergo the invasive strategy if their angina was absent or controlled or it was tolerated,” said Dr. Alice Jacobs, director of the Cardiac Catheterization Laboratory and Interventional Cardiology at Boston Medical Center. She wasn’t involved in the new research.

Still, doctors are often uncomfortable limiting their treatment of clogged arteries to drugs, diet and exercise alone because they’re worried the patient will wind up suffering a heart attack or other heart-related illness, according to past AHA president Dr. Elliot Antman.

The new findings are expected to give physicians more confidence in saying no to invasive treatments, the experts said.

The study did not focus on people who are admitted to a hospital with a heart attack — these patients often receive bypass, angioplasty or stenting to quickly open a blocked artery.

Instead, the trial focused on patients with stable but severe heart disease.

A typical patient in this group might be a 71-year-old grandmother who has noticed during the past two months some chest heaviness walking from the parking lot to her grandkids’ soccer game, the AHA presenters said. Stress testing and imaging scans could reveal some moderately clogged arteries leading to her heart.

The new trial was very comprehensive, involving nearly 5,200 patients across 37 countries. Half were randomly assigned to undergo an invasive procedure: About three-quarters underwent angioplasty (most receiving a stent as well), while the others had a bypass operation.

The other half of patients were treated with medications and lifestyle changes alone.

Researchers mainly focused on whether the invasive procedure would reduce a patient’s risk of heart-related death, heart attack, hospitalization with unstable angina, heart failure or cardiac arrest.

Overall, an invasive strategy “did not demonstrate a reduced risk over a median 3.3 years” compared with the more conservative, drugs/lifestyle therapy, said trial co-chair Dr. Judith Hochman, a cardiologist and senior associate dean of clinical sciences at NYU Langone Health, in New York City.

However, invasive procedures did have a positive impact on one patient subgroup: People who regularly suffer the chest pain and shortness of breath associated with angina, said co-researcher Dr. John Spertus. He directs health outcomes research at Saint Luke’s Mid-America Heart Institute in Kansas City.

“For a patient who has weekly angina, there would be 15% of them who would be expected to be angina-free with the conservative approach, while 45% would be expected to be angina-free with the invasive approach,” Spertus said. “This is such a large difference that you would only have to treat about three patients with weekly angina for one to be angina-free at three months.”

On the other hand, patients who did not regularly have angina received only minimal quality-of-life or symptom benefits after undergoing an invasive procedure, Spertus added.

A smaller set of trials — this time focused on patients with chronic kidney disease — revealed even less promising results, researchers said. Patients didn’t gain any health benefits and didn’t have any improvement in their quality of life after getting an invasive treatment. Angioplasty might even help put them on dialysis earlier or increase their risk of stroke, the study found.

Dr. Glenn Levine, a professor of cardiology with Baylor College of Medicine in Houston, said that when it comes to kidney patients with clogged arteries, he “will treat them with medical [drug] therapy alone” unless they have marked or uncontrolled angina.

Experts said the main message from these studies is that doctors shouldn’t feel pressured to immediately send patients with clogged arteries into a catheterization lab, especially if they aren’t suffering any symptoms.

That could free up physicians to focus on getting patients to take their medications, Jacobs said. If drug therapy helps relieve their occasional angina or other symptoms, then angioplasty might be avoided in two out of every three patients, she estimated.

The trials were funded by the U.S. National Heart, Lung, and Blood Institute.

For more information:

There’s more on common heart procedures at the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Juul Delivers More Nicotine Than Other E-Cigarettes: Study

By Robert Preidt
HealthDay Reporter

FRIDAY, Nov. 15, 2019 (HealthDay News) — Juul electronic cigarettes deliver nicotine at a much higher rate than most other types of e-cigarettes, new research shows.

Juul is by far the leading e-cigarette brand sold in the United States, and is particularly popular among youth.

In the new study, researchers from Penn State University College of Medicine analyzed blood samples from six Juul users who were asked to puff on their device every 20 seconds for 10 minutes — a total of 30 puffs.

“The Juul users we studied obtained blood nicotine concentrations almost three times as high as most of the e-cigarette users we previously studied,” said study first author Jessica Yingst, a research project manager.

In fact, “Juul’s nicotine delivery is very similar to that of cigarettes,” she said in a university news release.

The Juul users were also asked to rate their withdrawal symptoms and other effects like nicotine craving and anxiety both before and after vaping. They had higher levels of nicotine dependence than more than 3,000 long-term users of other e-cigarettes, according to the study.

Juul Labs did not respond to a request for comment from HealthDay.

Prior studies of other e-cigarette brands with high liquid nicotine concentrations found that many delivered very little nicotine to the user, the researchers noted.

“In previous studies, we found that e-cigarette users were less addicted than smokers. However, the high nicotine delivery of the product and the scores on this study suggest that Juul is probably as addictive as cigarettes,” said study co-author Jonathan Foulds, a professor of public health sciences.

The researchers said the high addiction potential of Juul e-cigarettes is a good reason for nonsmokers to avoid them, but they may still offer smokers a less harmful form of nicotine consumption.

“In previous work, we determined that Juul delivered lower levels of some harmful chemicals than cigarettes and even some other e-cigarettes,” said study co-author John Richie, a professor of public health sciences.

E-cigarettes pose a dilemma for public health experts, according to Foulds.

Continued

“This type of product is likely addictive and is attractive to teenagers,” he said. “But those same qualities that make it addictive may enable it to help adult smokers switch to a much less harmful form of nicotine consumption.”

In recent weeks, Juul has announced that it would no longer sell mint, fruit or dessert flavors of its products.

The company made these moves as it faces widespread criticism that its flavored nicotine products are hooking a generation of teenagers on nicotine and vaping.

The company also faces multiple investigations by U.S. Congress, the U.S. Food and Drug Administration and several state attorneys general. Juul is also being sued by adults and underage vapers who allege they became addicted to nicotine by using Juul’s products.

The study was published Nov. 15 in the journal JAMA Open Network.

WebMD News from HealthDay

Sources

SOURCE: Penn State University, news release, Nov. 15, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Plants Will Not Boost Your Home’s Air Quality: Study

TUESDAY, Nov. 12, 2019 — Don’t count on potted plants to keep your home’s air clean.

Dispelling a common belief, researchers at Drexel University in Philadelphia found that natural ventilation does a far better job than houseplants in maintaining air quality in homes and offices.

“This has been a common misconception for some time. Plants are great, but they don’t actually clean indoor air quickly enough to have an effect on the air quality of your home or office environment,” said Michael Waring, head of Drexel’s indoor environment research group.

His team analyzed dozens of studies conducted over 30 years. Their findings were published online Nov. 6 in the Journal of Exposure Science and Environmental Epidemiology.

The researchers said air-exchange rates indoors — either natural or from ventilation — dilute concentrations of volatile organic compounds (VOCs) far faster than plants can pull them from the air. VOCs are the air pollutants that plants are supposed to clean.

Many of the studies reviewed did find that plants reduced concentrations of VOCs over time. This likely led to the widespread belief that plants can purify indoor air, the study authors said.

But it would take between 10 and 1,000 plants per square meter of floor space to match the air cleaning capacity of a building’s air-handling system or even just a couple of open windows in a house, the investigators found.

“This is certainly an example of how scientific findings can be misleading or misinterpreted over time,” Waring said in a university news release.

“But it’s also a great example of how scientific research should continually reexamine and question findings to get closer to the ground truth of understanding what’s actually happening around us,” he added.

More information

The American Lung Association has more on indoor air quality.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Opioids Won’t Help Arthritis Patients Long-Term: Study

SATURDAY, Nov. 9, 2019 — Opioid painkillers may temporarily ease the discomfort of arthritis, but they have no clear lasting benefit, a research review finds.

In an analysis of 23 clinical trials, researchers found that, on average, opioid medications were somewhat effective at easing pain in patients with osteoarthritis. That’s the common form of arthritis in which cartilage cushioning the joints gradually wears down, leading to swelling, stiffness and pain.

But the trials found no evidence that opioids improved patients’ quality of life or helped with their depression. And any benefits for pain seemed to wane with time.

“We found that the magnitude of these effects is small and continues to decrease over time,” said lead researcher Dr. Raveendhara Bannuru. He is director of the Center for Treatment Comparison and Integrative Analysis at Tufts Medical Center, in Boston.

Treatment guidelines for chronic pain, other than cancer-related pain, already say opioids should be a last resort.

With osteoarthritis, Bannuru said, the drugs are only recommended if a patient has not gotten relief from other medical therapies, and if surgery — like knee or hip replacement — is not an option.

Instead, patients should try to exercise regularly and maintain a healthy lifestyle. As for medications, Bannuru said, topical versions of nonsteroidal anti-inflammatory drugs (NSAIDs) — like ibuprofen and naproxen — are a “first choice.”

These creams or ointments help people avoid the side effects that can come with prolonged used of oral NSAIDs (such as Motrin, Advil, Aleve), Bannuru noted. Injections of hyaluronic acid, a substance in joint fluids, are another option, he said.

In addition, aerobic activity, like walking, and exercises that strengthen the muscles around the arthritic joint can be helpful, according to Dr. Steven Eyanson, a rheumatologist who was not involved in the study.

And if a patient is overweight, shedding some pounds can help ease pain and improve joint function, said Eyanson, a retired adjunct assistant professor at the University of Iowa in Iowa City.

“In the case of osteoarthritis, the benefits of therapy by opioid pain relief are very limited,” Eyanson said.

Bannuru was scheduled to present the findings Saturday at the American College of Rheumatology’s annual meeting, in Atlanta. Research presented meetings is generally considered preliminary until it is published in a peer-reviewed journal.

For the study, the researchers pooled the results of 23 previously published clinical trials that involved more than 11,400 osteoarthritis patients.

Overall, the investigators found, opioid treatment had a modest effect on people’s pain over two to 12 weeks. At higher doses, the drugs were actually less effective, and carried a higher risk of side effects, such as nausea, constipation and diarrhea.

“In light of dependency concerns and the discomfort that many patients feel while taking the drugs, it would appear that there is no optimal therapeutic window for the use of oral opioids in osteoarthritis,” Bannuru said.

The results come during a national crisis of opioid addiction that, according to government figures, is killing 130 Americans each day.

After years of skyrocketing, prescriptions for opioids — like OxyContin, Vicodin and Percocet — have been declining since 2012, according to the U.S. Centers for Disease Control and Prevention. In recent years, illegal opioids — like heroin and illicitly manufactured fentanyl — have become the biggest concern.

Still, prescription opioids were involved in 36% of opioid overdose deaths in 2017, the CDC says.

“We hope the results of our study will empower osteoarthritis patients to have informed discussions with their health care providers about the safest and most effective treatment options for their pain,” Bannuru said.

Eyanson said that, to him, “the take-home messages are that opioids have limited benefit in osteoarthritis pain control, and have significant potential for risk.”

Most osteoarthritis patients will benefit from a “more holistic approach” — including medication and non-drug therapies, and in some cases, surgery, he added.

More information

The Arthritis Foundation has more on treating osteoarthritis.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Kratom May Cause Liver Damage: Study

By Steven Reinberg        
       HealthDay Reporter

FRIDAY, Nov. 8, 2019 (HealthDay News) — The popular herbal supplement kratom may cause liver damage, researchers warn.

Kratom is widely available in smoke shops and online. It’s a botanical product made from Mitragyna speciosa, a tropical evergreen tree found in Southeast Asia. At low doses, it’s a stimulant. At high doses, it has an opioid-like effect.

Use of kratom has risen sharply since the start of the opioid epidemic, and more than 90 deaths have been linked to it, researchers say.

“There are risks associated with using kratom, and liver injury is on the list of things that are a potential consequence of using it,” said William Eggleston, a clinical assistant professor at the Binghamton University-State University of New York’s School of Pharmacy. He wasn’t involved with the study, but reviewed the findings.

There were eight cases of reported liver injury associated with kratom products in the study. Eggleston said this may not seem like a lot, but they are enough to be concerning.

“Maybe we need to re-evaluate whether or not this drug should be available as a dietary supplement,” he said.

Unlike prescription drugs, dietary supplements don’t need approval from the U.S. Food and Drug Administration.

And though kratom is a legal herbal supplement, the FDA has warned against its use. The agency has called it “opioid-like” and cited concerns that it might pose an addiction risk.

Some patients report that they have had a good experience with kratom for treating pain, mood disorders and opioid addiction, Eggleston said.

“However, we really don’t have any evidence in the medical literature as of yet to support that,” he said. “So whenever I have the opportunity to speak with a patient who’s using kratom, even if they’re having a positive experience, I certainly caution them that there are a number of potential risks. It is relatively unregulated, and to say that it works is not something that we really know yet.”

For the study, a team led by Dr. Victor Navarro, head of gastroenterology at Albert Einstein Healthcare Network in Philadelphia, looked at 404 cases of liver damage from dietary supplements. Eight of the cases, which occurred between 2007 and 2017, were tied to kratom.

Continued

Five patients used kratom to get high, and one used it for joint pain. All used the supplement for two to six weeks before signs of liver damage appeared.

Five patients had jaundice (a yellowing of the skin); six had itching; five had abdominal pain, and three had fever. Six patients were hospitalized, and all got better without the need for a liver transplant.

Dr. David Bernstein, chief of hepatology at Northwell Health in Manhasset, N.Y., said the study is a reminder that many over-the-counter supplements that people think are safe aren’t.

“People should be aware of this finding and that they have to read very carefully the labels of ingredients of anything that they put into their mouths,” said Bernstein, who had no part in the study.

Because of its dangers, kratom should be avoided, Bernstein warned. “Any over-the-counter product that contains this ingredient should be left on the counter,” he said.

Navarro is scheduled to present the findings Saturday at a meeting of the American Association for the Study of Liver Diseases, in Boston. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

WebMD News from HealthDay

Sources

SOURCES: William Eggleston, Pharm.D., clinical assistant professor, pharmacy practice, Binghamton University-State University of New York School of Pharmacy; David Bernstein, M.D., director, Sandra Atlas Bass Center for Liver Diseases, Feinstein Institutes for Medical Research, Manhasset, N.Y., and chief, hepatology, Northwell Health, Manhasset, N.Y.; Nov. 9, 2019, meeting presentation, American Association for the Study of Liver Diseases, Boston

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

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Kratom May Cause Liver Damage: Study

By Steven Reinberg        
       HealthDay Reporter

FRIDAY, Nov. 8, 2019 (HealthDay News) — The popular herbal supplement kratom may cause liver damage, researchers warn.

Kratom is widely available in smoke shops and online. It’s a botanical product made from Mitragyna speciosa, a tropical evergreen tree found in Southeast Asia. At low doses, it’s a stimulant. At high doses, it has an opioid-like effect.

Use of kratom has risen sharply since the start of the opioid epidemic, and more than 90 deaths have been linked to it, researchers say.

“There are risks associated with using kratom, and liver injury is on the list of things that are a potential consequence of using it,” said William Eggleston, a clinical assistant professor at the Binghamton University-State University of New York’s School of Pharmacy. He wasn’t involved with the study, but reviewed the findings.

There were eight cases of reported liver injury associated with kratom products in the study. Eggleston said this may not seem like a lot, but they are enough to be concerning.

“Maybe we need to re-evaluate whether or not this drug should be available as a dietary supplement,” he said.

Unlike prescription drugs, dietary supplements don’t need approval from the U.S. Food and Drug Administration.

And though kratom is a legal herbal supplement, the FDA has warned against its use. The agency has called it “opioid-like” and cited concerns that it might pose an addiction risk.

Some patients report that they have had a good experience with kratom for treating pain, mood disorders and opioid addiction, Eggleston said.

“However, we really don’t have any evidence in the medical literature as of yet to support that,” he said. “So whenever I have the opportunity to speak with a patient who’s using kratom, even if they’re having a positive experience, I certainly caution them that there are a number of potential risks. It is relatively unregulated, and to say that it works is not something that we really know yet.”

For the study, a team led by Dr. Victor Navarro, head of gastroenterology at Albert Einstein Healthcare Network in Philadelphia, looked at 404 cases of liver damage from dietary supplements. Eight of the cases, which occurred between 2007 and 2017, were tied to kratom.

Continued

Five patients used kratom to get high, and one used it for joint pain. All used the supplement for two to six weeks before signs of liver damage appeared.

Five patients had jaundice (a yellowing of the skin); six had itching; five had abdominal pain, and three had fever. Six patients were hospitalized, and all got better without the need for a liver transplant.

Dr. David Bernstein, chief of hepatology at Northwell Health in Manhasset, N.Y., said the study is a reminder that many over-the-counter supplements that people think are safe aren’t.

“People should be aware of this finding and that they have to read very carefully the labels of ingredients of anything that they put into their mouths,” said Bernstein, who had no part in the study.

Because of its dangers, kratom should be avoided, Bernstein warned. “Any over-the-counter product that contains this ingredient should be left on the counter,” he said.

Navarro is scheduled to present the findings Saturday at a meeting of the American Association for the Study of Liver Diseases, in Boston. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

WebMD News from HealthDay

Sources

SOURCES: William Eggleston, Pharm.D., clinical assistant professor, pharmacy practice, Binghamton University-State University of New York School of Pharmacy; David Bernstein, M.D., director, Sandra Atlas Bass Center for Liver Diseases, Feinstein Institutes for Medical Research, Manhasset, N.Y., and chief, hepatology, Northwell Health, Manhasset, N.Y.; Nov. 9, 2019, meeting presentation, American Association for the Study of Liver Diseases, Boston

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });

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Playing More Than One Sport Helps Teen Athletes Avoid Injuries: Study

SATURDAY, Nov. 2, 2019 — Teen girls who play several sports have a lower injury risk than those who focus on just one, a new study finds.

It included more than 1,100 girls who play basketball, soccer and volleyball. Most were middle and high school students; some were in college.

Girls who specialize too early in sports such as basketball, soccer and volleyball could find that a single-minded focus “may hinder motor development and lead to compromised hip and knee coordination during dynamic landing and jumping activities, which can lead to increased chance of potentially life-altering injuries,” said lead author Christopher DiCesare. He’s a biomechanist in the Division of Sports Medicine at Cincinnati Children’s Hospital Medical Center in Ohio.

The study also found that girls who focused on a single sport had a higher rate of hip and knee injuries and an increased risk of knee pain.

Researchers said playing multiple sports may improve girls’ coordination, and that those who specialize may not fully develop neuromuscular coordination patterns that can reduce the risk of injury.

Due to uneven growth in bone mineral and muscular and connective tissue strength before and during puberty, young athletes may be less able than older ones to handle the physical stresses associated with focusing on one sport, the study published Oct. 23 in the Journal of Athletic Training concluded.

“By understanding the influence that sport specialization has on coordination and the potential for injuries, there is the potential to make better decisions of when it may be appropriate to safely specialize in a sport,” DiCesare said in a journal news release.

More than 30 million young people participate in individual or team sports, and an increasing emphasis on the success has pushed many to specialize.

More information

The American Academy of Pediatrics has more on sports.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Antihistamines Linked to Delayed Care for Severe Allergic Reaction: Study

MONDAY, Oct. 28, 2019 — Giving antihistamines to a child suffering a potentially fatal allergic reaction may do more harm than good if it causes a delay in emergency treatment, a new study warns.

Researchers reviewed the medical records of young patients, aged 8 months to 20 years, who were admitted to a pediatric intensive care unit for treatment of anaphylaxis between July 2015 and January 2019.

The investigators found that 72% of patients who took antihistamines at home delayed seeking medical care, compared to 25% who didn’t take antihistamines.

“Anyone experiencing symptoms of anaphylaxis, which can constrict airways and circulation, should seek medical care immediately and use an epinephrine auto-injector if they have been prescribed one,” said lead author Dr. Evan Wiley, a pediatric resident at Jacobi Medical Center in New York City.

But many families first turn to antihistamines and wait to see if they might ease the allergic reaction, he said. That can be a risky mistake.

The findings were to be presented Sunday at the American Academy of Pediatrics (AAP) annual meeting, in New Orleans. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

“While the use of antihistamines might help some allergic symptoms such as rash or itching, those medications will not prevent death from anaphylaxis,” Wiley said in an AAP news release. “It is important for patients with anaphylaxis to seek immediate medical care, since the only proven lifesaving treatment is epinephrine, and any delay in receiving appropriate treatment can be fatal.”

The most common trigger for anaphylaxis is food allergies, which are on the rise in children, according to the U.S. Centers for Disease Control and Prevention.

More information

The Mayo Clinic has more on symptoms and causes of anaphylaxis.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Don’t Delay Surgery for Very Early-Stage Breast Cancer, Study Suggests

THURSDAY, Oct. 24, 2019 — Delaying surgery for a noninvasive breast cancer can have dire consequences, a new study shows.

Longer delays in surgery for ductal carcinoma in situ (DCIS) breast cancer lead to a higher risk of invasive ductal carcinoma and a slightly lower survival rate, researchers found.

“For each month of delay, there was well under a 1% difference in survival. But for each month of delay, there was an approximate 1% increase in the finding of invasive cancer,” said study author Dr. Richard Bleicher, a professor of surgical oncology at Fox Chase Cancer Center, in Philadelphia.

“The survival difference with a delay is small,” Bleicher noted in a center news release. “While it’s not an emergency to get treated immediately, delays do have an effect and long delays should be avoided.”

DCIS occurs when abnormal cells form in the milk duct of the breast and is the earliest stage of breast cancer. When cancerous cells spread beyond the milk duct, it becomes invasive ductal carcinoma.

Standard treatment for DCIS is surgery and radiotherapy, along with endocrine therapy. But research suggests that some DCIS may never progress to invasive disease, and clinical trials are being conducted to determine whether DCIS can be observed, rather than surgically removed.

This study “suggests that delays in operative management of DCIS are associated with invasion and slightly worse short-term outcomes,” Bleicher said. “Since observation represents infinite delay, it suggests that observation should not yet be pursued outside of a clinical trial in patients who will tolerate excision.”

The study included more than 140,600 U.S. women (123,947 with DCIS, 16,668 with invasive ductal carcinoma). They were diagnosed between 2004 and 2014.

Survival was compared with five time intervals in delays to have surgery: less than 30 days, 31-60 days, 61-90 days, 91-120 days, or 121-365 days.

Overall survival was 95.8%, with a median time from diagnosis to surgery of 38 days. However, each increase in diagnosis-to-surgery interval was associated with a 7.4% increase in the risk of death.

The study was published Oct. 21 in the Annals of Surgical Oncology.

More information

The American Cancer Society has more on treatment of DCIS.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Stress in Pregnancy May Affect Baby’s Sex, Preterm Delivery Risk: Study

By Robert Preidt
HealthDay Reporter

WEDNESDAY, Oct. 16, 2019 (HealthDay News) — Physical and mental stress during pregnancy may influence the baby’s sex, and physical stress may increase the risk of preterm birth, a new study suggests.

Researchers assessed 187 healthy pregnant women between 18 and 45 years of age. About 17% were mentally stressed, with high levels of depression, anxiety and perceived stress. Sixteen percent were physically stressed, with higher daily blood pressure and calorie intake than other women in the study.

Women with either physical or psychological stress were more likely to have a girl, the study found. Typically, about 105 males are born for every 100 females. But the male-to-female ratios in this study were 4:9 among women with physical stress and 2:3 among those with mental stress during pregnancy.

“Other researchers have seen this pattern after social upheavals, such as the 9/11 terrorist attacks in New York City, after which the relative number of male births decreased,” said study leader Catherine Monk, director of Women’s Mental Health at New York-Presbyterian/Columbia University Irving Medical Center in New York City.

“This stress in women is likely of long-standing nature; studies have shown that males are more vulnerable to adverse prenatal environments, suggesting that highly stressed women may be less likely to give birth to a male due to the loss of prior male pregnancies, often without even knowing they were pregnant,” Monk explained in a hospital news release.

Women under physical stress also were more likely to give birth prematurely, and their fetuses were more likely to have an indicator of slower central nervous system development.

Meanwhile, mentally stressed mothers had more birth complications, according to the findings.

“We know from animal studies that exposure to high levels of stress can raise levels of stress hormones like cortisol in the uterus, which in turn can affect the fetus,” Monk said.

“Stress can also affect the mother’s immune system, leading to changes that affect neurological and behavioral development in the fetus. What’s clear from our study is that maternal mental health matters, not only for the mother but also for her future child,” she concluded.

The study was published online Oct. 14 in the journal PNAS, Proceedings of the National Academy of Sciences.

WebMD News from HealthDay

Sources

SOURCE: Columbia University Irving Medical Center, news release, Oct. 14, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Study Links Asbestos in Talcum Powder to Deadly Cancer

MONDAY, Oct. 21, 2019 — As concerns about baby powder being contaminated with asbestos mount, a new study finds a link between such contamination and a rare and deadly cancer.

A group of 33 people developed mesothelioma after long-term use of talcum powder and no exposure to other sources of asbestos, the report stated.

“All of them had significant exposure to talcum powder,” said lead researcher Dr. Jacqueline Moline, a professor with Northwell Health’s Feinstein Institutes for Medical Research in Manhasset, N.Y.

“It wasn’t like they sprinkled it on once a month. These were people who used it daily or many times a day for many, many years. They all used the powders, and then over time they developed the cancers,” Moline said.

Just last week, Johnson & Johnson recalled a shipment of baby powder after U.S. authorities found it had been contaminated with asbestos — the first such recall in the company’s history, a spokesman said.

Johnson & Johnson did not respond to a request for comment on Moline’s study, but said in its recall announcement that it has rigorous testing standards in place to ensure the safety of its baby powder.

“Thousands of tests over the past 40 years repeatedly confirm that our consumer talc products do not contain asbestos,” the company’s statement said.

Mesothelioma is a cancer of the lining that covers the outer surface of most internal organs, according to the American Cancer Society. It most often occurs in the lining around the lungs or the abdomen.

Asbestos is the main risk factor for mesothelioma, the cancer society says. It’s fairly rare in the United States, with about 3,000 new cases diagnosed each year. But it has an average five-year relative survival rate of just 9%.

People usually inhale asbestos fibers, which are so small that 200,000 fibers fit on Abraham Lincoln’s nose on a penny, Moline said. The inhaled asbestos makes its way into the lining around the lungs and abdomen, where it causes DNA damage that triggers cancer.

Although most mesotheliomas can be tracked back to asbestos exposure, there always have been a number of cases that couldn’t be explained that way, Moline said.

Researchers have suspected that talcum powder could be one potential source of asbestos exposure, Moline said. Both minerals are mined from the earth, and sometimes asbestos and talc deposits overlap.

“The talc, when it’s mined, can be contaminated with asbestos when both minerals are present,” Moline said.

There’s no way to remove asbestos from talc, so the only way to protect consumers is to test what’s coming out of the mine, she said.

To examine the possible link between mesothelioma and talcum powder, Moline and her colleagues gathered information on 33 different people with the deadly cancer who’d not been exposed to asbestos in any other way.

They determined that talcum powder use was the only possible source of asbestos exposure among all 33 cases.

Further, a closer examination of six specific cases revealed the presence of asbestos in their tissues after decades-long use of talcum powder.

“They all had the same type of asbestos that is seen in talc in their tissues and in their mesothelioma,” Moline said. “The type of asbestos we found is not the type typically seen in commercial applications. It’s the type of asbestos you’d find in talc.”

In one case, a 65-year-old woman was diagnosed with mesothelioma around her left lung after she complained of a dry cough and short-windedness. She started using talc around age 8 or 9, and regularly used it throughout her life. Researchers found asbestos fibers in the tissue of her lungs and lymph nodes.

In another case, a 44-year-old man developed chest pain after playing hockey in 2012. Doctors found mesothelioma in the lining around his lungs. The man regularly used talcum powder after showering, as well as dousing his hockey gear with talc before donning it.

It’s hard for consumers to judge on their own whether a specific brand of talcum powder is safe, Moline said.

“The question is where does it come from and how rigorously has it been tested,” she said. “There are some mines that don’t have any asbestos, but it’s unclear whether those are being used by different manufacturers.

“The most prudent thing for folks is either to use talc-free powders, which are on the market, or cornstarch-based products,” Moline concluded.

The new study was published Oct. 17 in the Journal of Occupational and Environmental Medicine.

More information

The American Cancer Society has more about mesothelioma.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Fecal Transplants Benefit IBS Patients: Study

Oct. 21, 2019 — Fecal transplants from a “super-donor” reduced symptoms of irritable bowel syndrome (IBS) in many patients, a new study says.

It’s estimated that 10-15% of Americans have IBS, according to the American College of Gastroenterology. Abdominal cramping, bloating, constipation and diarrhea are among the symptoms. The condition doesn’t damage the intestines.

The cause of IBS hasn’t been pinpointed but some researchers believe it’s linked to abnormalities in the population of microorganisms in the gut. Fecal transplants — in which stool from a donor is processed and then transplanted into a patient’s gut — are meant to repopulate the gut with a healthier range of microorganisms, NBC News reported.

This study included 164 IBS patients who received either lower- or higher-dose fecal transplants or a placebo, which were delivered to the small intestine through a tube inserted into the mouth and down the throat.

Moderate symptoms improvement was reported by 23.6% of patients in the placebo group, 76.9% of those in the lower-dose fecal transplant group, and 89.1% of those in the higher-dose group, NBC News reported.

Symptoms went away entirely in 5.5% of patients in the placebo group, 35.2% of those in the lower dose group, and 47.3% of those in the higher dose group, according to the study presented at the annual United European Gastroenterology Week in Spain.

One year after the study, the benefits of fecal transplant appear to have lasted, noted lead researcher Magdy El-Salhy, a professor in the Department of Clinical Medicine at the University of Bergen, in Norway.

“The preliminary results [suggest] most, 90-95%, of the responded patients are still well and about 50% are still ‘cured,'” he told NBC News.

The donor was healthy, had been breast-fed, had a nutritious diet, took no regular medications, was a nonsmoker and had taken antibiotics only a few times, El-Salhy noted.

The fact that the study used a so-called super donor raises questions, experts said.

“These are very promising results that will certainly generate a lot of interest and attention because there is a great interest in these kinds of therapeutics for IBS,” Dr. Alexander Khoruts, medical director of the Microbiota Therapeutics Program at the University of Minnesota, told NBC News.

“But it’s not clear how you could find another ‘super donor’ to reproduce these results,” Khoruts added.

WebMD News from HealthDay

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Study Uncovers Racial Gaps in Treatment of Multiple Myeloma

FRIDAY, Oct. 18, 2019 — There are significant racial disparities in treatment of U.S. patients with multiple myeloma, a new study shows.

Researchers reviewed nationwide data on 3,504 white, 858 black and 468 Hispanic patients treated from 2007 to 2013.

The average time between multiple myeloma diagnosis and start of treatment was 2.7 months for whites; 4.6 months for Hispanics; and 5.2 months for blacks.

Drugs are usually the first course of treatment for this type of blood cancer. If treatment is delayed, patients can suffer organ damage, kidney problems, anemia, broken bones, infections and other serious health problems.

“We noted that minorities are not getting introduced to treatment early enough to derive adequate clinical gains,” said lead author Dr. Sikander Ailawadhi, an oncologist at the Mayo Clinic in Jacksonville, Fla.

Over the study period, the odds of beginning treatment within six months of diagnosis increased for the three groups. However, the improvement was greater among whites and Hispanics than among blacks.

Autologous stem cell transplant is considered the standard of care for eligible patients. Transplant rates within a year of diagnosis increased among whites and blacks, but not among Hispanics.

Median overall survival was similar across all three groups. (Median means half survived longer, half for a shorter time.) But the authors said a comparison to previous research suggests the survival rate for blacks could have been better if they had equal and timely access to treatment.

“Since our analysis is based on Medicare patient data, these disparities cannot be attributed to differences in insurance coverage. Patients are not receiving treatment equally even in this ostensibly equal-access setting,” Ailawadhi noted in an American Society of Hematology news release.

Researchers also found that medical costs were highest among Hispanics. Their average total monthly medical cost was $ 12,657, compared with $ 11,546 for blacks and $ 10,143 for whites.

The authors said the higher amount for Hispanics could be due in part to higher hospitalization costs, possibly because of complications resulting from delayed treatment.

Ailawadhi said further research is needed to investigate reasons underlying the racial disparities.

“We hope that understanding and addressing them will lead to more equitable health care access, cost, and outcome profiles for all multiple myeloma patients, regardless of race or ethnicity,” he concluded.

The study was published Oct. 17 in the journal Blood Advances.

More information

The American Cancer Society has more on multiple myeloma.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Is Melanoma Suspected? Get 2nd Opinion From Specialist, Study Says

By Robert Preidt
HealthDay Reporter

FRIDAY, Oct. 11, 2019 (HealthDay News) — Melanoma is the most lethal type of skin cancer, and a new study finds that the diagnosis of a suspect lesion gains accuracy when a specialist pathologist is brought on board.

Many patients with melanoma are first diagnosed by general practitioners, dermatologists or plastic surgeons. A biopsy sample of the suspect lesion might then be sent to a general pathologist for further diagnosis, explained a team from the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA).

However, getting a second opinion from a pathologist specially trained in skin lesions — a dermatopathologist — yields the most accurate results, the new study found.

“A diagnosis is the building block on which all other medical treatment is based,” said study co-leader Dr. Joann Elmore, a professor of medicine and a researcher at the cancer center.

Her team noted that, of all pathology fields, analysis of biopsies for skin lesions and cancers has one of the highest rates of diagnostic errors. Those errors can affect the lives of millions of patients each year.

“On the other end of these biopsies are real patients: patients answering the late-night, anxiety-inducing phone calls when we inform them of their diagnosis; patients undergoing invasive surgeries; patients weighing their next clinical steps,” Elmore said in a UCLA news release.

“All patients deserve an accurate diagnosis. Unfortunately, the evaluation and diagnosis of skin biopsy specimens is challenging with a lot of variability among physicians,” she added.

Dr. Michele Green, a dermatologist at Lenox Hill Hospital in New York City, agreed.

“A diagnosis of skin cancer can be overwhelming,” said Green, who wasn’t involved in the new study. “It is imperative that patients know the training of the pathologist reviewing their specimen to ensure the accuracy of the diagnosis given.”

In their research, Elmore’s team found that getting a second opinion from pathologists who are board-certified, or have fellowship training in dermatopathology, can greatly boost the accuracy of a melanoma diagnosis.

The study included 187 pathologists — 113 general pathologists and 74 dermatopathologists — who examined 240 skin biopsy lesion samples. Misclassification rates of the lesions was lowest when first, second and third reviewers were subspecialty trained dermatopathologists.

Continued

On the other hand, the most misclassifications were made when reviewers were all general pathologists without the subspecialty training.

“This is definitely something that health care providers should consider when faced with these complex and challenging-to-diagnose skin biopsies,” Elmore said. “Our results show having a second opinion by an expert with subspecialty training provides value in improving the accuracy of the diagnosis, which is imperative to help guide patients to the most effective treatments.”

Green agreed. Reading over the findings, she said that “it is safe to conclude that second opinions performed by trained dermatopathologists yield more accurate diagnoses.”

Dr. Scott Flugman is a dermatologist at Northwell Health’s Huntington Hospital in Huntington, N.Y. He said the new study “reinforces what many dermatologists consider to be true about the care of patients with pigmented lesions.”

But he noted that for many Americans, the first inkling that they might have melanoma does not come from a dermatologist — and that can lead to problems.

“The overwhelming majority of dermatologists will insist on having their biopsies read by a board-certified dermatopathologist,” Flugman explained. “But this practice is not always followed when biopsies are done by plastic surgeons, general surgeons or family practitioners. It is important for these other specialists to request a second opinion by a dermatopathologist when diagnosing pigmented lesions read by general pathologists.”

And, as the study showed, a general pathologist should not be the final stop in the diagnostic journey.

As Flugman noted, the UCLA study found that even though more than 70% of the general pathologists interviewed had more than a decade of experience, “only 13.3% of general pathologists stated that their colleagues consider them an expert in melanocytic skin lesions.”

According to Flugman, “this reinforces the importance of having the input of a board-certified dermatopathologist when diagnosing these potentially difficult cases.”

Of course, even the best diagnostic approach is not foolproof, the experts said.

“While these findings suggest that second opinions rendered by dermatopathologists improve overall reliability of diagnosis of melanocytic lesions, they do not eliminate or substantially reduce misclassification,” Elmore said.

The study was published online Oct. 11 in JAMA Network Open.

WebMD News from HealthDay

Sources

SOURCES: Scott Flugman, M.D., dermatologist, Northwell Health’s Huntington Hospital, Huntington, N.Y.; Michele S. Green, M.D., dermatologist, Lenox Hill Hospital, New York City; University of California, Los Angeles, news release, Oct. 11, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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WebMD Health

Paper Books Beat Tablets for Parent-Child Interactions, Study Finds

MONDAY, Sept. 30, 2019 — Parents seeking quality reading time with their toddlers would do well to choose an old-fashioned book over a newfangled e-reader, a new study argues.

Parents and kids appear to have a better shared experience when they’re reading a book together than when they read with a tablet, researchers report.

Parent and child tended to tussle over the tablet, explained lead researcher Dr. Tiffany Munzer, a fellow in developmental behavior pediatrics at the University of Michigan’s C.S. Mott Children’s Hospital.

“In this study, print books were great for promoting an environment that was rich with reciprocity, but the tablet appeared to create some conflict between parents and toddlers who were both trying to control the tablet,” Munzer said.

This study isn’t the first by Munzer to raise questions regarding the value of e-books when reading to young children. Another study published in Pediatrics last March looked at verbal interactions when parent and child shared an e-book.

In that study, parents and toddlers talked more when reading print books, and were more likely to hold the book or turn pages together. Toddlers presented with an e-book became focused on tapping or swiping the screen and didn’t pay as much attention to either the story being told or the parent reading to them.

Munzer’s latest study focused on nonverbal signs of “social reciprocity” — the back-and-forth exchanges that happen between parents and children when they’re sharing a task.

This act of sharing “creates moments of joy, and is the foundation for child development. It is how children learn new words, gain emotional competence, and builds on their problem-solving abilities,” Munzer said. “Social reciprocity is how relationships are nurtured and is important for our future generation’s development and achievement.”

In the latest study, Munzer and her University of Michigan colleagues observed 37 parent-toddler pairs reading together in a laboratory using three different book formats — print, basic e-readers and enhanced e-books on tablets.

The enhanced e-readers contained extra elements like sound effects and animation. The basic e-books allowed for swiping to turn the pages and tapping illustrations to elicit the appearance of words, but there was no auto-narration or sound effects.

The three books were all from Mercer Mayer’s “Little Critter” series, and were similar in length and reading difficulty.

The researchers found differences in nonverbal communication from both parents and children when engaging with a tablet, Munzer said.

“Children used the tablet books in a more solitary or independent fashion, which prevented parents from easily viewing or accessing the book and made it harder for parents to communicate with their children,” Munzer said.

Both the toddlers and their parents also tried to exert control over the experience when reading with a tablet. Rather than working together, they would push each other’s hand away or move the tablet away from each other. Toddlers might even try grabbing the tablet.

“These behaviors may interfere with the back-and-forth engagement between parents and children,” Munzer said.

The findings were published Sept. 30 in the journal JAMA Pediatrics.

Pediatricians often stress the beneficial aspects of reading with your toddler, including better language development and more positive social interactions, said Dr. David Fagan, vice chair of pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y.

These findings show that “in the 21st century we as pediatricians need to think about technology as it pertains to reading,” Fagan said. “We can’t assume that reading with your child equates to sharing a book.

“It seems that tablets are perceived by children as solitary devices to be controlled by them, and their use in shared reading may promote negative interactions,” Fagan continued. “So, the message to parents about reading needs to emphasize using traditional books, and if parents choose to read on a tablet with their child they need to be aware of the behaviors described in this study.”

Dr. Michael Grosso, chief medical officer and chair of pediatrics for Northwell Health’s Huntington Hospital in Huntington, N.Y., said “more studies of this kind are clearly warranted.”

Grosso was reminded of a science fiction story by Isaac Asimov while reading this study.

“The author described an advanced technology that involved a user interface that allowed one to modulate the flow of information from the device using nothing other than one’s eyes and mind control,” Grosso said. “The author was describing, of course, a book. Books — and parents reading to children — are as valuable for children now as they ever were.”

More information

The Nemours Foundation has more about reading to your toddler.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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