18 October 2018
THURSDAY, Oct. 18, 2018 (HealthDay News) — Smoking electronic cigarettes could slow the healing of skin wounds as much as regular cigarettes, according to a new study on rats. “Based on our findings, e-cigarettes are not a safe alternative to traditional cigarettes as it relates to timely wound healing,” said study corresponding author Dr. Jeffrey Spiegel. He’s chief of facial plastic surgery at Boston Medical Center. It’s long been known that smoking regular cigarettes impairs wound healing, and surgery patients are advised to avoid smoking for several months before an elective operation. Some smokers believe e-cigarettes are safer than regular smokes. But there has been little research into whether that’s really the case, particularly following an operation. In this study, laboratory tests on rats showed that both e-cigarettes and regular cigarettes resulted in increased tissue death, which delays wound healing. “Providers, and patients, need to understand the risks of both types of smoking so that they can make the best decision to keep the patient as safe as possible before and after surgery,” Spiegel said in a medical center news release. The results were published Oct. 18 in the journal JAMA Facial Plastic Surgery. Research involving animals may not provide the same results in humans. More information The U.S. National Library of Medicine has more on smoking and surgery.
18 October 2018
THURSDAY, Oct. 18, 2018 (HealthDay News) — Countering standard advice, a new study finds that skin creams are safe to use in moderation for cancer patients receiving radiation treatment. “Patients are routinely advised not to apply anything on the skin prior to treatment,” explained radiation oncologist Dr. Lucille Lee, of Northwell Health Cancer Institute in Lake Success, N.Y. According to Lee, who wasn’t involved in the new research, the concern has been that skin creams might somehow boost the amount of radiation absorbed by the skin. That could worsen “the skin reaction, which is the primary side-effect of breast irradiation,” she said. The new study was conducted by a team at the University of Pennsylvania. Nearly two-thirds of cancer patients in the United States receive radiation therapy, the researchers said, and as many as 90 percent of those patients develop radiation dermatitis, a rash or burn on the skin. Patients often turn to prescription and over-the-counter skin cream treatments for relief. But in a survey conducted by the study authors, 91 percent of 105 doctors and nurses said they told patients to avoid the creams before radiation therapy, and 83 percent of 133 patients said they’d received the warning from their doctors. However, the study’s lead author, Dr. Brian Baumann, believes the warnings are “a holdover from the early days of radiation therapy.” According to Baumann, who is adjunct assistant professor of radiation oncology at Penn, “With the use of modern radiation treatments that can reduce dose to the skin, we hypothesized that it may no longer be relevant.” His team conducted laboratory experiments to test that idea. The researchers used a high-tech device that measured the amount of radiation absorption in the presence of two creams: an over-the-counter ointment called Aquaphor; and silver sulfadiazine cream, which is only available by prescription. The investigators found that, unless applied very heavily, skin creams did not raise the radiation dose to the skin. “Based on the results of this study, the use of topical agents just before radiation therapy can be safely liberalized, which may improve quality of life for patients undergoing radiation therapy,” Baumann said in a university news release. But “very thick applications of topical agents just before radiation therapy should still be avoided,” he added. For her part, Lee said patients should consult with their doctors on the issue. “Describing what constitutes a thin versus thick layer of cream is completely subjective,” she said. “Personally, I tell patients that if they apply a cream before the treatment, and if she cannot see it or feel it, not to worry or feel that she needs to take a shower to wash it off,” Lee said. The study was published Oct. 18 in the journal JAMA Oncology. More information The American Cancer Society has more on radiation therapy.
18 October 2018
THURSDAY, Oct. 18, 2018 (HealthDay News) — Protein is key to your well-being and deserves a significant place in every diet. Knowing the best sources can boost your health as well as help you feel more satisfied on fewer calories. Seafood is an excellent protein source, with dozens of types of fish and shellfish to try. Eat a 3.5-ounce serving at least twice every week, and include fish high in omega-3 fatty acids, such as salmon and trout. These are nutrients that your body needs, but can’t make, so you must get them through your diet. Make friends with the manager of the seafood section at your favorite market and don’t be shy about asking for the freshest choices. Note: It’s usually seafood that’s past its prime that’s guilty of smelling up your kitchen, not fresh fish. Chicken and turkey are other well-known protein sources, but you may not realize that it’s OK to cook them with the skin on to keep the meat moist. Just remove it before eating. Also, keep in mind that breast meat has less fat and therefore fewer calories than dark meat. Be sure to put vegetable proteins on the menu. These include legumes such as beans and lentils. They have a protein-fiber combo that helps regulate blood sugar as well as fill you up. What about red meat? For many people, it’s fine to eat it once a week or so. But choose lean cuts — skip the cold cuts, hot dogs and other cured meats — and limit the portion size to three ounces. Trim off as much fat as you can before cooking, and pour off any melted fat before eating. Also use healthier cooking methods, such as baking, broiling and grilling on a rack, which allow fat to drain off. More information The American Heart Association has tips to help you get more non-beef sources of protein into your diet.
18 October 2018
THURSDAY, Oct. 18, 2018 (HealthDay News) — Lisa Hanson was first diagnosed with the leg swelling and fluid retention of lymphedema when she was just 17. Now in her 40s, she reconciled herself to a lifetime of long pants, compression hose and a nightly, hours-long bout with an electric pump to keep the swelling down. She said her lymphedema made her feel like “a freak.” But now, millions of people like Hanson may have a new treatment option. Researchers from Stanford University and other institutions conducted two new pilot studies, and report that ketoprofen, a common anti-inflammatory drug, significantly eases swelling and other skin damage from lymphedema. “For a long time I couldn’t talk to people about my lymphedema without crying because it’s something weird and obscure,” Hanson said in a university news release. “Now there is hope for people like me with this disease.” A condition affecting millions Lymphedema refers to painful fluid buildup in a limb, often after lymph node removal due to cancer treatment. The prescription medicine ketoprofen is a cousin to over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil) and naproxen (Aleve), said lead author Dr. Stanley Rockson, director of Stanford’s Center for Lymphatic and Venous Disorders. Ketoprofen is approved by the U.S. Food and Drug Administration for “chronic forms of inflammation that need an aggressive approach” such as arthritis, he said. But using it for lymphedema — which affects about 3 million people in the United States — appears to alleviate the burdensome condition, according to the small new studies. Lymphedema often results after cancer surgery (most notably breast cancer), but it can also be due to infection or other trauma, according to background notes. Lymphedema has no cure. Current treatments include compression garments, electric pumps and massage therapy to move lymph fluid manually through tissues. Rockson said ketoprofen could be an important add-on to those treatments. “What’s dramatic for me, having worked with lymphedema patients now for 30 years, is that the traditional thought about lymphedema is it progresses from fluid accumulation to progressive, structural, irreversible damage,” Rockson said. “We’re gratified to see that these supposedly irreversible results are not irreversible,” he added. Real improvement Rockson and his colleagues undertook a pair of small trials. First, 21 lymphedema patients took a 75-gram dose of ketoprofen by mouth three times a day for four months. The researchers performed skin biopsies at the start of the trial and again four months later to measure disease severity. Based on encouraging findings, the follow-up trial enrolled 34 lymphedema patients, with 16 receiving ketoprofen and 18 receiving a placebo drug. Ketoprofen recipients showed reduced skin thickness as well as improvements in other factors related to skin health and elasticity. “After a couple of months, I remember going home one day and taking my compression stockings off and looking at my leg, thinking, ‘Wow, my skin is wrinkly, that’s so weird,'” said Hanson, who took part in the trials. “The skin wasn’t so taut or thick. It was more like normal.” She stressed that in her case at least, ketoprofen is “not a cure,” but it has produced a real improvement. “Over time, the swelling has gone down,” Hanson said. “It doesn’t make it go away, but it has been easier to take care of my leg.” An ‘exciting’ new option Rockson said researchers also got the impression that patients treated with ketoprofen experienced a significant decrease in infections, though the studies didn’t specifically analyze that aspect. The drug works by blocking an inflammatory pathway in the body, he noted. Like other NSAIDs, side effects of ketoprofen can include gastrointestinal upset or bleeding. Lymphedema patients who’d like to consider taking ketoprofen should speak with their doctors and weigh their risk factors, Rockson said. “It’s certainly an option,” he said, adding he still hopes to tweak the drug’s structure to better suit lymphedema specifically in the future. “It will, for a majority of users, make lymphedema better and hopefully at least prevent progression. But there’s a list of adverse effects that need to be considered, so that needs to be an individual decision,” Rockson added. Several experts who treat patients with lymphedema praised the studies for potentially providing a new option for this group. “The lymphatic system is very complicated and there’s not a lot of research on how it functions,” said Lisa Marshall, director of oncology rehabilitation at the Graham Cancer Center and Research Institute at Christiana Care Health System in Newark, Del. “We don’t have a lot of options … as lymphedema patients get to the chronic state. So the fact that there’s now a drug that could enhance our outcomes that we could use as an [addition] to our treatments is very exciting,” added Marshall, who played no role in the new research. Dr. Shubhada Dhage is director of breast surgical services at NYU Winthrop Hospital in Mineola, N.Y., and also wasn’t involved with the new studies. She said she was “highly optimistic” about the results, though small numbers of patients were tested. “How this [research] will translate and have an impact currently with lymphedema is yet to be known,” Dhage said. “If the doctors of a particular patient are on board with [prescribing ketoprofen], it might be worth trying.” The studies were published Oct. 18 in the journal JCI Insight. More information The U.S. National Cancer Institute offers more on lymphedema treatment.
17 October 2018
WEDNESDAY, Oct. 17, 2018 (HealthDay News) — Contrary to popular belief, new research suggests that drinking coffee might be a good prescription for avoiding the unsightly skin condition known as rosacea. The finding is based on an analysis of rosacea risk and dietary habits among nearly 83,000 women who were enrolled in a national nurses’ study between 1991 and 2005. And it appears to challenge longstanding wisdom that those who struggle with rosacea should avoid both caffeine and hot drinks of any kind. “In our study, we found that consuming caffeine from coffee may protect against the risk of developing rosacea,” said study author Wen-Qing Li. But the study did not prove that coffee causes rosacea risk to drop. Li is an assistant professor of dermatology and epidemiology at Brown University in Providence, R.I. Rosacea is a common chronic inflammatory condition that affects the face in the form of flushing and blushing, and sometimes acne-like bumps. Former President Bill Clinton struggles with the disease, while Britain’s Princess Diana had rosacea, too. As to how much caffeine would be needed to reduce rosacea risk, Li said that coffee drinkers who consumed as little as 100 milligrams (mg) of caffeine a day saw a 4 percent drop in rosacea risk. And those who consumed four or more servings of coffee a day saw a “significant” drop in rosacea risk when compared with those who consumed less than one cup a month, the researchers found. But calculating serving size can be tricky. The Mayo Clinic notes that an 8-ounce cup of coffee typically contains between 95 mg and 165 mg of caffeine, while the study team indicates that one would need to drink at least two servings of coffee a day to reach the 100 mg threshold. On the other hand, the Center for Science in the Public Interest points out that a single 20-ounce “venti” serving of Starbucks Blonde Roast coffee contains about 475 mg of caffeine, while a single “large” 20-ounce serving of Dunkin’ Donuts coffee with Turbo Shot contains about 400 mg. The other outstanding question is exactly why caffeine might reduce rosacea risk in the first place. Li said the jury is still out, but he pointed to its potential impact on the strength of vascular contractions and the immune system. Risk reduction, he added, may also originate in caffeine’s impact on levels of key hormones — such as adrenaline, noradrenaline and cortisol — or in the antioxidant agents it contains. Still, Li stressed that the apparent association was only seen among coffee drinkers. No protection was linked to consuming other caffeinated substances, including tea, sodas or chocolate. Nor was any protective benefit linked to the consumption of decaffeinated coffee. In fact, the analysis suggested that eating chocolate may actually increase rosacea risk, though Li noted that “the findings cannot preclude the potentially protective effect of caffeine consumed in other forms.” Among the larger pool of women in the study, about 5,000 had been diagnosed with rosacea at some point prior to 2005. The research team then matched those rosacea diagnoses against detailed food and beverage reports taken every four years since 1991. The study was published Oct. 17 in the journal JAMA Dermatology. Dr. Robert Kirsner, chair of the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine, suggested that while the findings were “intriguing,” they should be interpreted with caution, given that “an association does not imply causality.” He was not involved with the research. Nevertheless, Kirsner said the findings may “help direct patients regarding dietary choices” and may ultimately lead to new therapies involving coffee. Dr. Mary Wu Chang, a clinical professor of dermatology and pediatrics with the University of Connecticut School of Medicine, agreed that the findings make sense, even if they are a “little bit surprising.” But Chang, who had no role in the study, noted that the degree of benefit observed was “not that much. So I’m not sure what to conclude or recommend, based on this.” More information The American Academy of Dermatology has more on rosacea.
16 October 2018
WEDNESDAY, Oct. 17, 2018 (HealthDay News) — Adding to growing alarm about America’s opioid crisis, cases of a potentially deadly heart infection have jumped 10-fold among North Carolina’s injection drug users, new research shows. The infection is endocarditis, which strikes one or more of the heart’s four valves. Usually a byproduct of aging, it can also develop when bacteria is introduced into the body through use of injected drugs such as heroin. “We know that drug-associated endocarditis is increasing nationally, but the magnitude of the rise has been somewhat stunning,” said study author Dr. Asher Schranz, a fellow in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill. Between 2007 and 2017, endocarditis-related hospitalizations and surgeries involving injection drug users in North Carolina rose more than 10-fold, with most of the rise occurring since 2013, the study found. The median age of patients who had surgery for drug-related endocarditis was 33, meaning half were older, half younger. That’s far younger than the norm. The North Carolina findings echo a similar trend in West Virginia. In April 2018, Charleston Area Medical Center experts reported a statewide doubling of drug-related endocarditis admissions between 2008 and 2015. Still, North Carolina’s dramatic spike surprised investigators. Up until the early 2010s, other studies had shown drug-associated endocarditis increasing two- or threefold, Schranz said. A North Carolina study last year, however, reported a 12-fold rise between 2010 and 2015. “In our study,” Schranz said, “we found that this problem has continued to sharply rise through at least mid-2017.” Schranz explained why: Typically, endocarditis risk is driven by age, as heart values weaken over time, he said. The weakened valves can become infected if bacteria or fungi enter the blood, which, he noted, can make an otherwise routine event such as a dental cleaning a high-risk venture for seniors. The damage can also occur when people inject drugs. “Those damaged heart valves may then become infected if that person injects bacteria into the bloodstream by not properly sterilizing the skin, or by injecting non-sterile water or drugs,” Schranz explained. The upshot: Endocarditis has become “a severe consequence of the opioid crisis that has received insufficient attention,” Schranz said. Besides compromising heart valve integrity, endocarditis can raise the risk for heart failure, strokes and/or joint infections. Open-heart surgery to replace a damaged heart valve with a prosthetic is often required. Schranz and his team’s analysis of a statewide database revealed that nearly 23,000 patients were hospitalized with endocarditis between 2007 and 2017, and more than 1,650 underwent surgery. As recently as 2013, fewer than 10 surgeries a year were done to treat drug-related endocarditis, the study found. By 2017, that figure stood at 109. Compared with other cases, drug-related endocarditis patients were more likely to be women, white, uninsured, Medicaid recipients, and young. “The opioid crisis has dramatically impacted the health of young persons in the U.S.,” Schranz said. “There has been increasing hepatitis C and a large outbreak of HIV in Indiana due to drug use. However, we feel that endocarditis is a severe consequence of the opioid crisis that has received insufficient attention.” Dr. Arthur Williams is an assistant professor at Columbia University’s Division on Substance Use Disorders, in New York City. He said the rising heart infection rates among injection drug users underscore the urgent need to get the nation’s opioid epidemic under control. “Sky-high rates of endocarditis reflect the total failure of our treatment system to successfully shepherd patients with opioid use disorders into quality care with FDA-approved medications — such as buprenorphine — which have repeatedly shown to reduce injection-related behaviors and reduce or eliminate opioid use,” said Williams. He was not involved with the study. Schranz and his colleagues presented their findings earlier this month in San Francisco at IDWeek, a joint meeting of experts from the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Disease Society. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal. More information The American Heart Association has more on endocarditis.
16 October 2018
TUESDAY, Oct. 16, 2018 (HealthDay News) — Stimulating a specific set of nerves that are nestled along the spine may deliver relief to those who suffer from chronic back pain and cut the need for opioid painkillers, new research suggests. The therapy, which targets the root ganglion nerves, is more effective than other spine stimulation procedures because it places tiny leads precisely at the area where pain originates, unlike other devices that provide more generalized stimulation, the researchers said. “In certain patients who have not gotten relief from other treatments, this therapy may give sustained pain relief and may allow them to reduce opioids for at least 18 months and perhaps longer,” said lead researcher Robert McCarthy. He’s a professor of anesthesiology at Rush University Medical Center in Chicago. The dorsal root ganglions are nerve cells, on both sides of each of the spine’s vertebra, and are the gateway to pain between nerves in different parts of the body, spinal cord and brain. Stimulating this area interrupts pain signals between the painful area and the brain, the researchers explained. A pacemaker-like device implanted under the skin in the lower back sends small electronic pulses through a wire placed near the specific dorsal root ganglion associated with the pain, McCarthy said. The pulses replace pain with tingling or numbness. The strength of stimulation, programmed by a doctor, is based on the patient’s level of pain, he said. The treatment has two advantages over spinal cord stimulation, McCarthy said. In spinal cord stimulation, a wire runs along the spinal cord sending pulses along the entire spine, but the pulses don’t target the specific pain source. In addition, dorsal root ganglion stimulation requires significantly lower levels of electric current to quell pain, McCarthy said. The goal of this study, he said, was to judge the effectiveness of the therapy over a long period. McCarthy and his colleagues implanted the device in 67 people suffering with chronic back pain and followed them for three to 18 months. Among the participants, 17 had the device for over a year. Before receiving the device, most patients rated their pain as an 8 on a scale of one to 10, with 10 being the worst. For most patients, the device reduced pain by 33 percent, which was significant, the researchers reported. In addition, patients said they experienced a 27 percent reduction in disability or limitations on daily activities caused by pain. In all, 94 percent of the participants said the treatment was beneficial. The procedure was not without complications. Five patients needed to have the wires implanted again, two patients had them removed because they were infected, and one had the device removed because of a complication. McCarthy said the therapy is not widely available, even though it was approved by the FDA in 2016. At the moment, its use is confined to more advanced medical centers where doctors have been trained in how to implant and regulate the device. Also, the procedure isn’t covered by all insurance companies, so out-of-pocket costs to patients can be very high. It is, however, covered by Medicare, he said. For uninsured patients, the cost of having spine stimulation devices can range from $15,000 to $50,000 or more, according to a 2008 report funded by the Washington State Department of Labor and Industries. Spine stimulation is usually approved only after patients have not responded to other treatment, according to Blue Cross Blue Shield. Other insurance companies may have varying policies. McCarthy hopes that more doctors will be trained in the procedure and that it will become more available, especially because it has the potential to allow patients to stop taking opioids to control their pain. One pain specialist not involved with the study saw the benefits of this procedure. “The results of this study are very significant,” said Dr. Kiran Patel, director of neurosurgical pain at Lenox Hill Hospital in New York City. It shows long-term data that patients experienced significant pain relief and functional improvements, she said. “In my pain practice and career, dorsal root ganglion stimulation therapy has been one of the most effective technologies available to combat chronic pain,” Patel said. “I encourage chronic pain patients to seek out physicians who are trained and experienced in the application of dorsal root ganglion stimulation therapy to determine if they are a candidate,” she said. The findings were presented Sunday at the American Society of Anesthesiologists annual meeting, in San Francisco. Research presented at meetings is considered preliminary until published in a peer-reviewed journal. More information Visit the U.S. National Institute of Neurological Disorders and Stroke for more on back pain.
15 October 2018
MONDAY, Oct. 15, 2018 (HealthDay News) — Bloodstream infections contracted during a hospital stay are usually caused by a patient’s own digestive tract, not a doctor’s dirty hands or another patient’s cough, a small new study suggests. Stanford University researchers used new computer software to quickly identify the source of bloodstream infections among 30 patients. The findings showed that the infections mostly started in patients’ own bodies — often in the large intestine. Being able to trace these infections to their source, rather than guessing, is a big step toward addressing the risk factors, said Dr. Ami Bhatt, an assistant professor of hematology and genetics at Stanford. “Until now, we couldn’t pinpoint those sources with high confidence,” Bhatt said in a university news release. “That’s a problem because when a patient has a bloodstream infection, it’s not enough simply to administer broad-spectrum antibiotics. You need to treat the source, or the infection will come back.” The new program could help doctors rapidly learn if the germ responsible for a bloodstream infection came from a break in the skin, leaked through the intestinal wall, or was on the surface of a catheter or bed rail. This, in turn, would mean better steps toward eradicating the infection, she said. Bhatt’s team focused on the gut for the study because it’s the home of 1,000 to 2,000 different germs. These bugs usually don’t cause any problem, Bhatt said. “They’re perfectly well-behaved in the gut. It’s only when they show up in the wrong place — due, for example, to leaking through a disrupted intestinal barrier into the bloodstream — that they cause trouble,” she explained. In the study, the researchers analyzed blood and stool samples from patients who developed bloodstream infections when they had bone-marrow transplants between October 2015 and June 2017 at Stanford Hospital. In addition, each patient’s entire gene sequence was also analyzed. The researchers didn’t find much evidence that any patient’s bloodstream germ matched strains in other patients’ blood or stool. “I don’t think we’re passing around active infections among one another as often as has been assumed,” Bhatt said. The report was published online Oct. 15 in the journal Nature Medicine. More information For more about hospital-acquired infections, visit the U.S. Centers for Disease Control and Prevention.
15 October 2018
MONDAY, Oct. 15, 2018 (HealthDay News) — In the flooding and devastation left by Hurricane Michael, Americans faced with the clean-up are facing a new health threat: mold. Mold-related illnesses are a serious concern following severe flooding in the path of the storm, say experts from the University of Connecticut School of Medicine. “Where there’s dampness and water, there’s mold,” said Paula Schenck, of the division of occupational and environmental medicine. “Mold is an indicator of a whole soup of biological material. Unhealthy exposure to these bioaerosols is very possible after a flood from a hurricane and especially during cleanup efforts 24 to 48 hours after the storm,” she said in a university news release. Exposure to mold primarily affects the lungs and the skin, Schenck said. How you react to mold depends on the severity of your exposure. Some people may be more susceptible to mold-related illnesses than others, including children and those with a weakened immune system, asthma or another chronic illness. Warning signs of mold-related health issues include: Nasal congestion and sneezing. Hoarse voice and throat irritation. Cough, wheezing, shortness of breath or chest tightness. Flare-up of asthma symptoms. Respiratory symptoms. Extreme tiredness. These symptoms may not develop right away, Schenck noted. She advised doctors to be extra vigilant about educating their patients about mold risk following a storm or natural disaster. During a post-storm cleanup, the UConn experts advised the following: Assume any areas exposed to water or flooding for more than 24 hours have mold — even if it’s not apparent. While cleaning mold, use an “N95” respirator that has bands to hold the mask close to the face. Dust and surgical masks will not protect against mold and mold spores. People at high risk for mold-related illnesses should not attempt to personally clean up following a flood. If water damage covers more than 100-square-feet, seek professional help with the cleanup. Wear protective clothing. Cover the skin on the arms, hands, legs and feet while cleaning mold. Use long rubber gloves that extend to the middle of the forearm. Wear unvented goggles during mold cleanup to protect the eyes. Clean hard surfaces with soapy water. Avoid using bleach or other “fungicides” unless there is contamination from other flooded materials, such as sewage. These harsh chemicals aren’t more effective than soapy water and could cause or worsen lung irritation. Don’t attempt to clean soft materials and porous surfaces like fabrics and wall board. Throw away these items. More information The U.S. Environmental Protection Agency offers more on hurricane safety and preparedness.