Cold and Flu Sufferers Should Ease Back Into Fitness Routine

TUESDAY, Feb. 19 (HealthDay News) -- Although physical activity can help boost your immune system, people who are sick should tone down their workout or skip it altogether, experts advise.

"Regular exercise is a great way to reduce stress and sleep better at night. This helps boost your immune system. However, vigorous exercise and extreme conditioning can have a negative impact on your health if you're sick," Joe Berg, a personal trainer and fitness specialist at Loyola Center for Health, said in a Loyola University news release.

"When fighting a viral illness, it's best to keep your exercise session short and not as intense. If you have a fever or stomach bug it might be best to hold off," Berg added.

For those recovering from an illness, it's best to ease back into a workout routine slowly. Berg recommends starting small with some light aerobics, such as walking and cycling at an easy pace as well as body weight squats, push-ups and planks. In the plank exercise, you rest your weight on your forearms with your elbows directly beneath your shoulders, keeping your body in a straight line from your head to your feet.

"These exercises cover the major muscles of the body and when performed in moderation, can help boost your immune system," explained Berg.

For people worried about being exposed to germs at the gym, Valerie Walkowiak, medical integration coordinator at the Loyola Center for Fitness, pointed out that heading outside or working out at home may be a good way to stay healthy and fit during the cold and flu season.

"Weather permitting, it's always great to just get out of the house and walk or run to get in some cardio exercise. Just make sure you wear the proper clothes to keep warm. This includes layers of clothing, a hat, scarf, gloves and appropriate shoes," said Walkowiak.

When the weather makes exercising outdoors impossible, there are ways people can work out at home -- even if they don't have special equipment. Walkowiak said you can get your heart rate up without leaving the house by climbing the stairs, jogging in place or doing jumping jacks. She added that a home-based circuit training routine can be created by alternating two to three minutes of these cardio exercises with 30 to 60 seconds of strength-training moves, such as push-ups, squats, seated rows or heel raises.

"You don't have to have dumbbells, bands or tubing to get in some strength training at home. Try using household items to add resistance such as soup cans, gallon jugs of water or your own body weight," Walkowiak noted.

In order to target all the muscle groups, Walkowiak recommended doing the following exercises:

Chest, shoulder and triceps: do push-ups on the floor or against a wallBack, rear shoulders and biceps: try seated or standing row exercises using soup cans Legs, glutes and core: perform squats, sit-to-chair stands or lunges Calfs: do heel raises on the edge of a step Core: do planks, abdominal crunches, abdominal twists and leg raises Biceps: do bicep curls using soup cansTriceps: using a soup can or weighted object do kickbacks or over presses

Anyone who does go to the gym should remember to wipe down machines and wash their hands often, the experts advised.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Loyola University Health System, news release, Feb. 14, 2013

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1 in 8 Americans Diagnosed With Type 2 Diabetes: Poll

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Feb. 20 (HealthDay News) -- A staggering one in eight Americans has been diagnosed with type 2 diabetes, a new Harris Interactive/HealthDay poll suggests.

And more than one third of those polled have been diagnosed with diabetes or have a parent, sibling, spouse or child with the condition.

"Type 2 diabetes has become one of the most common and fastest growing diseases. Fully one in eight adults -- approximately 29 million people -- now report that they have been diagnosed with this dangerous condition," said Harris Poll Chairman Humphrey Taylor.

Added Dr. Ronald Tamler, clinical director of the Mount Sinai Diabetes Center in New York City: "Diabetes is very insidious. You don't know you're in trouble until the complications hit or until it's so out of control you have uncontrolled urination and thirst" -- two of the common symptoms of diabetes.

While type 2 diabetes is occurring in epic proportions, the new poll also found that awareness of the disease is still surprisingly low, with only 21 percent of those surveyed considering themselves well-versed on the disease. That means the remaining 79 percent may not know they're at risk or may already have the disease, which is known as the "silent" killer.

But people already diagnosed with diabetes tend to be much more aware of the health risks, with slightly more than two-thirds considering themselves either "extremely" or "very" knowledgeable about the disease, the poll found.

Still, 35 percent of respondents with diabetes said their diabetes was only "somewhat" controlled and 5 percent said it was "not at all" well controlled.

"Because diabetes is a chronic condition, the treatment of which is critically dependent on patient behavior and self-care, this may be the most alarming finding," Taylor said.

On a more encouraging note, many people polled do understand that a number of factors can contribute to type 2 diabetes, including being overweight (79 percent of respondents realize this is a risk factor), diet (74 percent) and physical inactivity (62 percent).

These numbers were greater among people who had been diagnosed with diabetes.

Interestingly, 60 percent of respondents know that genetics can be a component of type 2 diabetes.

"We have a public perception that type 2 diabetes is entirely a disease of lifestyle and that is not true," said Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association. "There is no question that lifestyle contributes to it, but the problem is one of biology . . . Environment really does play a role but the biology sets them up."

Indeed, certain ethnic groups, including many Native American tribes, bear a disproportionate diabetes burden, Ratner added.

Most adults, whether they actually have diabetes or not, seem fairly knowledgeable about the long-term consequences of the disease, which can include amputation of limbs, blindness, kidney disease and heart disease, the poll found.

There was an exception. Only 39 percent of adults overall and 56 percent of those with type 2 diabetes knew that the disease can cause strokes.

"People need to be aware that this is another disease caused by diabetes that can be prevented," said Nancy Copperman, director of Public Health Initiatives at North Shore-LIJ Health System in Great Neck, N.Y. "The idea of having a stroke might motivate them to change their lifestyle."

The disease seems to be taking a toll on those polled, with 20 percent acknowledging it has been a "significant" burden and 43 percent saying it has been "somewhat" of a burden for themselves and their families. The burden comes in the form of dietary restrictions, medication costs, eye problems, cardiovascular problems and foot problems.

In addition, 9 percent of people with type 2 diabetes said the condition has rendered them unable to work.

Still, with awareness of genetic factors as well as lifestyle contributors, "you can live a very full and happy life and thrive with diabetes," said Mount Sinai's Tamler.

In people with type 2 diabetes, either the body doesn't produce enough of the hormone insulin or cells can't use the insulin properly. Insulin is necessary for the body to use glucose -- blood sugar -- for energy. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications, according to the American Diabetes Association.

The prevalence of type 2 diabetes found in this new poll is higher than that reported by the U.S. Centers for Disease Control and Prevention, although the CDC data is more rigorous, Ratner said.

The poll was conducted online within the United States by Harris Interactive from Feb. 4 through 6, among 2,090 adults aged 18 and older. The survey was not based on a probability sample, so no estimate of theoretical sampling error can be calculated.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Humphrey Taylor, chairman, The Harris Poll; Ronald Tamler, M.D., Ph.D., clinical director, Mount Sinai Diabetes Center, New York City; Nancy Copperman, R.D., director, Public Health Initiatives, North Shore-LIJ Health System, Great Neck, N.Y.; Robert Ratner, M.D., chief scientific and medical officer, American Diabetes Association

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Health Tip: Eating for Healthier Teeth

(HealthDay News) -- Most parents know the importance of brushing and flossing, but what you eat also is crucial to maintaining good dental health.

The Academy of Nutrition and Dietetics offers this advice to help preserve a child's dental health:

Kids should eat foods rich in calcium, such as dairy foods, dark and leafy green vegetables, and almonds.They should also eat phosphorous-rich foods, such as eggs, fish and lean meats.And they should eat vitamin C-rich foods, such as citrus fruits, potatoes, tomatoes, spinach and broccoli.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Spinach Recalled in 39 States

By Lisa Habib
WebMD Health News

Reviewed by Brunilda Nazario, MD

Feb. 19, 2013 -- Spinach that might have E. coli bacteria contamination is being recalled in 39 states.

Taylor Farms Retail Inc., says it is voluntarily withdrawing organic baby spinach sold in 5-ounce or 16-ounce salad trays under five brand names that have a "best by" date of Feb. 24, 2013:

Central Market OrganicsFull Circle OrganicsMarketside OrganicSimple Truth OrganicTaylor Farms Organic

The spinach may be contaminated with E. coli,but the company says it knows of no one who has gotten sick. If you have this spinach, Taylor Farms says you shouldn't eat it -- throw it away. The company does not say how E. coli might have contaminated the spinach.

The recalled organic baby spinach was sold in these states:

Alabama Alaska Arizona Arkansas California Colorado Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maryland Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina Oklahoma OregonPennsylvania South Carolina Tennessee Texas Utah Virginia WashingtonWisconsin Wyoming

More information about the affected products is available on the Taylor Farms web site or by calling the company at 855-293-9811.

SOURCE: News release, Taylor Farms Retail Inc.

©2013 WebMD, LLC. All Rights Reserved.

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Sharp Rise Seen in Robotically Assisted Hysterectomies

By Serena Gordon
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Nearly 10 percent of hysterectomies in the United States are performed robotically, say researchers who found the "robo" procedures jumped dramatically between 2007 and 2010.

But they question whether robotic surgery is preferable to another minimally invasive procedure, laparoscopic surgery, for women having their uterus removed for non-cancerous conditions. While the two procedures have similar complication rates, the robotically assisted hysterectomy costs roughly $2,200 more than the laparoscopic procedure, according to the new study.

"The robotically assisted procedure was substantially more expensive," said the study's lead author, Dr. Jason Wright, an assistant professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons, in New York City.

Wright said more work is needed to determine which women would benefit from robotic hysterectomy.

"This data also raises a lot of questions about surgical innovations and the need to find ways to better study them before they diffuse into practice," he added.

Results of the study are published in the Feb. 20 issue of the Journal of the American Medical Association.

Hysterectomy is a common treatment for non-cancerous gynecological conditions, such as fibroids, endometriosis and excessive bleeding. As many as one in nine U.S. women will undergo such a procedure, according to the study.

Different surgical techniques exist for performing a hysterectomy. One choice is traditional open surgery, where a surgeon removes the uterus through a 5- to 7-inch opening in the abdomen. Another is vaginal hysterectomy -- removal of the uterus through the vaginal opening. Laparoscopy is done with special tools that allow surgeons to perform the surgery using only small incisions. Robotically assisted surgery is similar to laparoscopic surgery, but the surgeon uses a robotic device instead of a laparoscope to do the procedure.

Dr. Michael Zinner, chief of surgery at Brigham and Women's Hospital in Boston, said there are advantages to robotically assisted surgery in certain situations.

"The robotic device is easy to learn," Zinner said. "The wrist on the machine gives you [greater flexibility] unlike a straight laparoscope that's more like a chopstick. If the surgeon has any slight tremor, the machine evens it out," he said. In cases such as prostate surgery, where the surgery must take place in a very confined space and there's a significant risk of nerve damage, the delicate, articulating robotic device can be ideal, he said.

But for larger areas of the body, a laparoscope generally works just as well. "Nobody talks about using robotic surgery for removing the gallbladder," noted Zinner, because it would be more expensive without providing an additional benefit. Zinner co-wrote an editorial in the same issue of the journal.

In the current study, Wright and his colleagues reviewed data from more than 264,000 women who had a hysterectomy for a non-cancerous condition.

Robotically assisted hysterectomies were performed 0.5 percent of the time in 2007. By 2010, that number had jumped to 9.5 percent. The rate of laparoscopic surgery also increased during this time period, from 24.3 percent to 30.5 percent, according to the study.

At hospitals that introduced robotically assisted hysterectomy, its use quickly rose, the study found. But at hospitals without the robotic option, use of laparoscopic hysterectomy increased during the same time period. Overall, abdominal and vaginal hysterectomies declined.

Robotically assisted hysterectomy was less likely to lead to a hospital stay of two days or more compared to laparoscopic surgery, but the two procedures were similar in all other measured complications.

Where the two procedures differed most significantly was in cost, with $6,679 the median fee for a laparoscopic hysterectomy versus $8,868 for the robotically assisted procedure.

Joel Weissman, deputy director and chief scientific officer at the Center for Surgery and Public Health at Brigham and Women's Hospital and co-author of the editorial, said the robotic machine costs about $1.5 million and requires extra personnel.

"It's a little bit unclear who's paying the extra cost," he said. "It seems like at this point in time, insurers are paying the same whether the surgery is robotically assisted or not. But hospitals have to somehow pay those extra costs."

If you're considering a robotically assisted procedure, Zinner and Weissman advised talking with your doctor about which procedure will deliver better results. If two procedures are similarly effective, they suggested comparing costs.

In the case of hysterectomy, because robotically assisted surgery and laparoscopic surgery have similar results but significantly different costs, Zinner said he'd like to see more surgeons training in the laparoscopic procedure.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jason Wright, M.D., Levine Family Assistant Professor of Women's Health, Columbia University College of Physicians and Surgeons, New York City; Joel Weissman, Ph.D., deputy director and chief scientific officer, Center for Surgery and Public Health, and associate professor of health policy, Brigham and Women's Hospital, Boston; Michael Zinner, M.D., chief of surgery, Brigham and Women's Hospital, and clinical director, Dana Farber-Brigham and Women's Cancer Center, Boston; Feb. 20, 2013, Journal of the American Medical Association

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Tips to Avoid Return Trip to the Hospital

TUESDAY, Feb. 19 (HealthDay News) --More than 1 million Americans end up back in the hospital just weeks after they're discharged, and many of those readmissions are preventable, according to an expert from Columbia University School of Nursing in New York City.

Patients can do their part to avoid return trips to the hospital by simply paying attention and speaking up when it's time to go home, advised Mary Donovan-Johnson, program director of the Acute Care Nurse Practitioner Program.

"Discharges are often rushed and patients may be overwhelmed during this stressful time," Donovan-Johnson said in a Columbia news release. "If you don't understand something a medical provider said, don't be afraid to ask your doctor or nurse to repeat the instructions... Ask the person accompanying you home to listen and take notes when instructions are being explained by your medical team."

Other steps you can take to reduce the odds of readmission after discharge include:

Get all discharge instructions and information in writing, including directions for wound care, medications and food restrictions. Keep these instructions in a place where they are easily accessed. After discharge, follow through on your treatment by filling prescriptions and taking medications as directed. If you have questions about your medications or other instructions, call your doctor. Schedule follow-up visits with your doctor and blood tests or other procedures as directed, and keep those appointments.

"Ideally, the same team of doctors and nurses who worked with the patient would discharge them since they know the protocol in their medications, wound care, and how to set up the safest environment at home for them. But unfortunately, that doesn't always happen," Donovan-Johnson said. "So the patient needs to be vigilant about being an active participant in their recovery."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Columbia University School of Nursing, news release, Feb. 18, 2013

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Human Teeth Healthier in the Stone Age Than Today: Study

TUESDAY, Feb. 19 (HealthDay News) -- Something to think about next time you're in the dentist's chair: Ancient humans had healthier teeth than people do today, researchers say.

This decline in oral health over the past 7,500 years is the result of changes in oral bacteria due to human evolution and industrialization, the study authors said. These changes have led to chronic oral and other health problems, according to the report published Feb. 18 in Nature Genetics.

"The composition of oral bacteria changed markedly with the introduction of farming, and again around 150 years ago," explained study leader Alan Cooper, a professor and director of the University of Adelaide's Australian Centre for Ancient DNA, in a center news release. "With the introduction of processed sugar and flour in the Industrial Revolution, we can see a dramatically decreased diversity in our oral bacteria, allowing domination by caries [cavities]-causing strains. The modern mouth basically exists in a permanent disease state."

The international team of researchers examined DNA that had been preserved in tartar -- calcified dental plaque -- found on 34 prehistoric northern European human skeletons. They used these samples to analyze how oral bacteria changed from the Stone Age to the last hunter-gatherers, medieval times and later with the introduction of food manufacturing in the Industrial Revolution.

The evolution of human behavior and diet have had a negative impact on oral health, the investigators said.

"This is the first record of how our evolution over the last 7,500 years has impacted the bacteria we carry with us, and the important health consequences," Cooper said. "Oral bacteria in modern man are markedly less diverse than historic populations and this is thought to contribute to chronic oral and other disease in post-industrial lifestyles," he pointed out.

Study lead author Christina Adler, now at the University of Sydney, added that "dental plaque represents the only easily accessible source of preserved human bacteria." And, she said in the news release, "Genetic analysis of plaque can create a powerful new record of dietary impacts, health changes and oral pathogen genomic evolution, deep into the past."

The researchers said their research is being expanded to include other periods in time, other areas of the world and other species, such as Neanderthals.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Australian Centre for Ancient DNA, news release, Feb. 18, 2013

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Health Tip: Using a Food Thermometer

(HealthDay News) -- Using a food thermometer can help ensure that food is cooked properly, reducing your risk of a food-borne illness.

The U.S. Food Safety and Inspection Service offers these suggestions:

Test food with an instant-read thermometer toward the end of its cooking time, but before you expect it to be fully cooked. Place the thermometer in the thickest area of the food, and make sure it is not touching any bone, gristle or fat.Use the U.S. Department of Agriculture's recommended guidelines to make sure your food is cooked to a safe temperature.Always use hot water and soap to wash your thermometer before and after each use.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Fraudulent Data May Have Led to Use of Risky Treatment in ICUs

By Amanda Gardner
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Studies loaded with fraudulent data may have encouraged the use of a treatment for patients in intensive care units that now appears to do more harm than good, new research shows.

At issue is hydroxyethyl starch, an intravenous solution sometimes used to replace lost blood volume in critically ill patients. According to a new review article in the Feb. 20 issue of the Journal of the American Medical Association, the starchy solution may instead boost their risk of death or kidney failure.

"Almost certainly, what is happening is that some of the starch molecules leak out of blood vessels into the kidney itself so the kidney doesn't work as efficiently," said Dr. David Taylor, chairman of pulmonary and critical care medicine at Ochsner Health System in New Orleans. He was not involved in the new review.

Luckily for American patients, hydroxyethyl starch is not commonly used in the United States, Taylor said. But the new analysis serves as a cautionary tale on how fraudulent data can end up endangering patients' lives.

As Taylor explained it, critically ill patients often develop leaky vessels, and so quickly require intravenous fluids to keep their blood pressure stable and to improve organ function.

One such fluid is simple saline or salt water, known as crystalloid solution. This is the cheapest fluid available, but it tends to leak out of blood vessels, which means it can also leak into the lungs, under the skin and into various organs.

As a result, researchers have spent considerable time and effort trying to find less leaky alternatives to saline. The protein albumin, derived from human blood, is commonly used after cardiac surgery, when the risk of fluid collecting in the lungs is high, Taylor explained. Although albumin is less leaky than saline, it is more expensive.

Hydroxyethyl starch is similar to albumin, but it contains starch molecules, which are less likely to leak out of the blood vessels than saline.

Still, many researchers had reservations about using a starch-based solution from the beginning, Taylor said.

"If you have salt water and it leaks out, you just get some salt into the tissue and it goes away with a little bit of time," he explained. On the other hand, "if you have starch in the tissue it's not so easy to get starch out of there, and many people were worried about the possibility of complications."

It turns out there was even more reason to be suspicious of any alleged benefits of hydroxyethyl starch. In 2011, investigators discovered that the lion's share of research on the treatment that was conducted by German anesthesiologist Dr. Joachim Boldt was fraudulent and had to be retracted.

So the author of the current paper wondered: Would the purported benefits of hydroxyethyl starch hold up once Boldt's data was excluded?

Led by Dr. Ryan Zarychanski, of the University of Manitoba in Winnipeg, Canada, the team pooled data from 38 previous studies on the issue, including those by Boldt.

That analysis concluded that patients who received hydroxyethyl starch did not fare any better than other types of fluid.

But when the Boldt studies were excluded from the mix, hydroxyethyl starch was actually associated with an increased risk of death, kidney failure and need for dialysis among patients, the new research found.

It's impossible to gauge how many patients were damaged by Boldt's falsified research, but this new study highlights "how the inclusion or exclusion of the Boldt papers associated with research misconduct can shift the balance toward harm," said Dr. Massimo Antonelli, author of an editorial accompanying the new study.

"It showed also how the worldwide administration of starches for volume replacement therapy have caused the increase of acute renal failure and affected mortality," said Antonelli, a professor of intensive care and anesthesiology at the Catholic University-A.Gemelli University Hospital in Rome.

He added that a task force of the Surviving Sepsis Campaign, an organization devoted to reducing death from sepsis, recently issued guidelines warning against using starches for fluid replacement.

"These findings will reinforce [those] recommendations," he said.

Taylor stressed, however, that it would still be helpful to find alternatives to both albumin and saline.

A person in the intensive care unit (ICU) can have 1-2 liters more of fluid going into their body than out, said Taylor. Each liter weighs 1 kilogram, or 2.2 pounds.

"It's possible to gain anywhere from 8-10 pounds in fluid [in the ICU] so it would be a great to have an alternative to 10 pounds of weight," he said. However, a starch solution "is not a good alternative because it increases the risk of dying or needing dialysis," Taylor said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David Taylor, M.D., chairman, pulmonary and critical care medicine, Ochsner Health System, New Orleans; Massimo Antonelli, M.D., professor, intensive care and anesthesiology, Catholic University-A. Gemelli University Hospital, Rome; Feb. 20, 2013, Journal of the American Medical Association

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Injuries Rising Among Young Dancers

TUESDAY, Feb. 19 (HealthDay News) -- A new study finds that 113,000 children and teens were treated for injuries related to dancing from 1991 to 2007, and the annual number of injuries grew by more than a third over that period.

Sprains and strains, or both, were most common, causing 52 percent of injuries, followed by falls, responsible for 45 percent of dance-related mishaps.

The study looked at dance injuries among children and young adults aged 3 to 19. All were treated in U.S. emergency rooms.

"Adolescents are still growing into their bodies and as such often develop imbalances that can lead to injury," said Eric Leighton, an athletic trainer in sports medicine at Nationwide Children's Hospital, in a hospital news release. "It's critical that intervention and injury prevention be made available to them to address balance, strength and functional body control deficits as they grow."

According to the study, the annual number of dance-related injuries grew from 6,175 injuries in 1991 to nearly 8,500 injuries in 2007. Forty percent of injuries occurred in dancers aged 15 to 19.

"We believe this could be due to adolescent dancers getting more advanced in their skills, becoming more progressed in their careers and spending more time training and practicing," Kristin Roberts, lead study author and a senior research associate at the Center for Injury Research and Policy at the hospital, said in the news release. "We encourage children to keep dancing and exercising. But it is important that dancers and their instructors take precautions to avoid sustaining injuries."

Senior author Lara McKenzie, principal investigator at the Center for Injury Research and Policy, added: "Safety precautions such as staying well-hydrated, properly warming up and cooling down, concentrating on the proper technique and getting plenty of rest can help prevent dance-related injuries."

The study appears in the February issue of the Journal of Physical Activity and Health.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Nationwide Children's Hospital, news release, Feb. 11, 2013

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As Economy Rebounds, More Folks Try Turning Back Hands of Time

TUESDAY, Feb. 19 (HealthDay News) -- Evidence of the economic upturn can be found in more than housing starts and auto sales: A new report shows that the number of cosmetic procedures grew 5 percent in 2012.

Botox injections and other types of minimally invasive treatments led the way as more people opted for these types of facial rejuvenation procedures, while the number who chose to "go under the knife" remained relatively stable, the findings revealed.

In total, there were 14.6 million minimally invasive and surgical plastic surgery procedures in 2012. There were also 5.6 million reconstructive plastic surgery procedures last year, an increase of 1 percent from 2011, according to annual statistics from the American Society of Plastic Surgeons (ASPS).

Minimally invasive procedures increased 6 percent, with more than 13 million procedures in 2012. The top five were:

There were nearly 1.6 million cosmetic surgical procedures in 2012, a 2 percent decrease from 2011. The top five surgical procedures last year were:

Breast augmentation (286,000 procedures, down 7 percent)Nose reshaping (243,000 procedures, no change)Liposuction (202,000 procedures, down 1 percent)Eyelid surgery (204,000 procedures, up 4 percent)Facelift (126,000 procedures, up 6 percent).

While cosmetic breast surgeries among women decreased 2 percent between 2011 and 2012, male breast reduction surgeries increased 5 percent, to nearly 21,000 in 2012, the report said.

"For the third consecutive year, the overall growth in cosmetic surgery continues to be driven by a significant rise in minimally invasive procedures, while surgical procedures remain relatively stable. We are aware, however, that patients who begin with less-invasive treatments with a plastic surgeon may opt for more invasive, surgical procedures once required," Dr. Gregory Evans, ASPS president, said in a society news release.

Reconstructive plastic surgery increased by 1 percent in 2012 and the top five procedures were:

Tumor removal (4.2 million, up 1 percent)Laceration repair (291,000, down 4 percent)Maxillofacial surgery (209,000, up 7 percent)Scar revision (171,000, down 2 percent)Hand surgery (123,000, up 3 percent).

Reconstructive breast reduction increased 8 percent, with 68,000 procedures performed in 2012, the report noted.

"Although breast reduction has many physical and psychological benefits for women with overly large breasts, obstacles remain in acquiring insurance coverage," Evans said. "It's promising to see gains in this and other beneficial, medically necessary surgeries."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Society of Plastic Surgeons, news release, Feb. 19, 2012

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Drug, Alcohol Abuse More Likely Among High School Dropouts

TUESDAY, Feb. 19 (HealthDay News) -- The link between poor academic performance and substance abuse just got stronger, with a new U.S. government report showing ties between the two.

High school seniors who dropped out of school before graduating were more likely to drink, smoke cigarettes and use marijuana and other illegal drugs, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration.

The researchers said their findings should prompt communities to develop strategies to keep teens in school and prevent problems with substance abuse.

"The fact that nearly one in seven students drops out of high school has enormous public health implications for our nation," SAMHSA Administrator Pamela Hyde said in an agency news release. "Dropouts are at increased risk of substance abuse, which is particularly troubling given that they are also at greater risk of poverty, not having health insurance, and other health problems. We have to do everything we can to keep youth in school so they can go on to lead healthy, productive lives, free from substance abuse."

The study revealed high school seniors (typically between 16 and 18 years of age) who dropped out of school were more than twice as likely to be smokers, or have smoked in the past month, than students who stayed in school. The study also found that more than 31 percent of seniors who didn't receive their diploma used drugs, compared with about 18 percent of students who had finished high school.

The researchers also noted that about 27 percent of high school dropouts smoked marijuana, while close to one in every 10 abused prescription drugs. Meanwhile, only about 15 percent of those who completed high school used marijuana and just 5 percent abused prescription drugs.

Dropouts were also more likely to drink -- the study showed that nearly 42 percent of seniors who didn't finish high school drank and about a third engaged in binge drinking.

In contrast, about 35 percent of those students who stayed in school drank and only about one-quarter said they binged on alcohol.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: U.S. Substance Abuse and Mental Health Administration, news release, Feb. 14, 2013

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Blame Common Colds on Your Chromosome 'Caps?'

By Amy Norton
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Some people seem to catch a cold every few weeks while others appear immune. Now a preliminary study suggests that the protective "caps" on your chromosomes could partly explain the mystery.

The study, reported in the Feb. 20 issue of the Journal of the American Medical Association, found that healthy young adults were more prone to catching a cold when their immune system cells had relatively short telomeres.

Telomeres are lengths of DNA that sit at the ends of your chromosomes. Think of them like the plastic caps at the ends of a shoelace: Telomeres help keep your chromosomes -- which carry your genes -- from fraying and sticking together.

As people age, their telomeres gradually get shorter, and research has linked shorter telomere length to older adults' risks of developing and dying from infections, cancer and heart disease.

"But there's been very little known about telomere length in young people, certainly in relation to health," said Sheldon Cohen, a professor of psychology at Carnegie Mellon University in Pittsburgh who led the new study.

Because colds and other respiratory infections are the most common health woe in younger people, Cohen's team decided to see whether telomere length mattered in their risk of developing a cold.

The researchers recruited 152 healthy 18- to 55-year-olds, and measured telomere length in the volunteers' T cells -- immune system cells that fight off infection. They then exposed the men and women to a cold virus via nasal drops, and quarantined them in a hotel to be monitored.

Over the next five days, 22 percent of the volunteers developed cold symptoms, and the odds were higher among those with shorter telomeres in a particular subtype of T cell. Of the one-third with the shortest telomeres, 26 percent became sick, versus 13 percent among the one-third with the longest telomeres.

"This is something new and provocative," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved in the research.

"All of us know some people who get one cold after another, and others who seem like they're able to be around people with colds but remain robust," said Schaffner, who is also a spokesman for the Infectious Diseases Society of America.

These findings, Schaffner said, raise the possibility that there is some role for the telomeres in our T cells.

"We're not all created equal in terms of our telomeres," he said. "Just like some of us are short, and some are tall."

What does that mean for you during cold and flu season? Nothing right now, according to both Schaffner and Cohen.

For one, nobody knows if they have skimpy telomeres. And even if they did, it's not clear whether there's anything they could do about it.

"There is a lot of research interest right now in whether it's possible to alter telomere length, either through some kind of behavioral change or a medication," Cohen said. "But we're pretty far from that point."

What's more, the current findings do not prove that shorter telomeres, per se, mean more cold misery. The researchers did account for other factors, such people's age, weight and race. But Cohen said there could be other explanations. It's possible, for example, that some genetic factor makes people have shorter T-cell telomeres and renders them more vulnerable to colds.

On the other hand, shorter telomeres may impair T cells' ability to battle cold viruses, Cohen said.

Still, no one knows yet whether these findings could one day have practical use.

"This is really the first evidence that this biomarker of aging may be important for 25-year-olds as well as 65-year-olds, and for acute health conditions as well as chronic," Cohen said.

Of course, you do not need to wait for any telomere-lengthening therapy to curb your risk of catching a cold. "Wash your hands," Schaffner advised. "And try to avoid people who are sneezing and coughing."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Sheldon Cohen, Ph.D., professor, psychology, Carnegie Mellon University, Pittsburgh; William Schaffner, M.D., chair, preventive medicine, Vanderbilt University School of Medicine, Nashville, Tenn.; Feb. 20, 2013, Journal of the American Medical Association

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Fluorescent Tracer 'Lights Up' Brain Tumor for Surgery

By Barbara Bronson Gray
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Neurosurgeons report that they harnessed the power of fluorescent light to illuminate a brain tumor so the entire growth could be removed.

A report describes a case in which a patient with glioblastoma swallowed a pill, called 5-ALA, and was taken to surgery about four hours later. The medication attached itself to tumor cells, causing them to glow brightly. Once the skull was opened, the doctors focused a blue light on the tumor, which gave the cancerous cells a pink glow, so the surgeons could differentiate malignant tissue from healthy tissue.

"This is a very, very good thing," said study author Mitchel Berger, chairman of neurosurgery at the University of California, San Francisco. "In this case, we just happened to notice we could see evidence of the tumor spreading along the way of the ventricles [a communicating network of brain cavities], which showed we could see tumor dissemination."

The authors noted that the best way to extend survival is to remove as much of the brain tumor as possible. The research is published in the Feb. 19 issue of the Journal of Neurosurgery.

It's not always easy to see precisely where a tumor has spread in the brain. Some types of tumors can be particularly difficult to identify and remove, even with the benefit of MRI and surgical microscopes.

The use of fluorescence appears to be more effective than MRI technology, at least in this case, because the glow allows surgeons to see microscopic remnants of the tumor and areas of the cancer that might be mistaken for edema, or swelling, Berger explained. "This is an inexpensive way to identify high-grade tumors," he said.

Glioblastomas are a fast-growing type of tumor that usually occurs in adults and affects the brain more often than the spinal cord, according to the U.S. National Cancer Institute.

Why do tumor cells respond differently to the fluorescent drug than the body's other cells do? Their metabolism involves porphyrin, which has a tremendous ability to absorb light, Berger explained. Porphyrin is an organic compound, like the pigment in red blood cells. The pill used in the case report is derived from porphyrin.

The report focused on the case of a 56-year-old man who had undergone resection of a glioblastoma located in the right occipital lobe of his brain in 2005. Several years later, when symptoms reappeared, an MRI scan showed three distinct, new sites of tumor in the patient's right temporal lobe.

In surgery, when the surgeons viewed the fluorescent tumor cells, they could tell rather than being a new tumor, the cancer had spread from its original location on the right side of the brain through a pathway along the wall of the right ventricle. The researchers found that the use of 5-ALA during surgery enabled them to see the actual pathway of the tumor as it had spread.

The use of 5-ALA changed the patient's prognosis. "Multi-centric disease worsens the prognosis," Berger explained.

While the technique has been used in Europe for several years, the U.S. Food and Drug Administration has not approved the use of 5-ALA in the United States. Any surgeons using 5-ALA do so with limited permission from the FDA, Berger noted. The medication, 5-ALA, is manufactured by DUSA Pharmaceuticals.

Dr. Michael Schulder, vice chairman of the department of neurosurgery at North Shore University Hospital in Manhasset, N.Y., explained that "while the FDA considers 5-ALA a drug, which would require a lengthy process for approval, neurosurgeons see it as a surgical aid, which would take far less time to get the OK."

While Schulder said he thinks 5-ALA probably will add about six months to the anticipated survival of patients with high-grade gliomas, he said that attempts to improve the ability to remove these tumors will only go so far. "In the end, however helpful the use of 5-ALA or similar compounds may be in the surgical removal of brain cancers, it won't be the answer. The treatments will have to be biological to truly have an impact on survival, and ultimately, on a cure."

Schulder said he thinks it would be possible for fluorescence to be used in other types of surgeries, if surgeons could become comfortable using a surgical microscope with the benefit of a special light (something neurosurgeons are accustomed to using). He noted that he also thinks the technique might apply to some spinal surgeries, where visualizing the spinal cord is critical.

Schulder said he thinks the use of fluorescence in cancer surgery is promising. "It's a very important concept: if you can see a tumor better, you can remove it without affecting healthy tissue."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Mitchel Berger, M.D., professor and chairman, neurosurgery, department of neurological surgery, University of California, San Francisco; Michael Schulder, M.D., vice chairman, department of neurosurgery, North Shore University Hospital, Manhasset, N.Y.; Feb. 19, 2013, Journal of Neurosurgery

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Fasting May Not Be Needed Before Cholesterol Test

By Brenda Goodman, MA
WebMD Health News

Reviewed by Louise Chang, MD

Nov. 12, 2012 -- The requirement to fast before a cholesterol check can be a major inconvenience.

People who forget to fast may be told to reschedule their appointments. For those who remember, sitting in a doctor's waiting room with a growling stomach can make for a rough start to the day.

Now a large new study shows that cholesterol levels aren't radically different in people who ate compared to those who fasted before their blood was drawn.

The study, which is published in the Archives of Internal Medicine, suggests that people may not need to fast before they get a cholesterol test.

Experts who were not involved in the research called the results an eye-opener.

"This information is actually very, very interesting. It might change how we approach a patient," says Suzanne Steinbaum, DO, a preventive cardiologist at Lenox Hill Hospital in New York City.

For the study, researchers looked at the results of all the cholesterol tests processed at the same lab during a six-month stretch in 2011. Because the lab does all the testing for the entire city of Calgary, Canada, that amounted to test results for more than 200,000 people. Doctors also recorded how long it had been since the patient had last eaten.

When researchers broke down the results by fasting time, they found little change. Overall, total cholesterol and HDL "good" cholesterol varied by less than 2%, depending on when a person had last eaten. Total cholesterol and HDL are important because they are the main measures used to calculate a person's risk for heart-related events.

LDL "bad" cholesterol was less than 10% different in people who'd recently eaten compared to those who had been fasting for at least eight hours.

Triglycerides, or blood fats, were the most sensitive to food. They varied by no more than 20% between people who had fasted and those who had not.

Because the study is just a snapshot in time, it has important limitations. It doesn't prove that cholesterol levels don't change significantly before and after a meal for individual patients.

Researchers say the small differences noted in the study may matter for some, including those who are taking specific medications to lower their cholesterol or triglycerides. Those patients may still need fasting tests.

But for many others, eating may not make a difference.

"For routine screening, we're suggesting that a 2% variance probably isn't going to be significant," says Christopher Naugler, MD, MSc, chief of clinical pathology at the University of Calgary, Canada.

Other experts agree.

"I think we've just taken for granted that we should do fasting for lipid testing," says Samia Mora, MD, a preventive cardiologist at Brigham and Women's Hospital, in Boston.

Mora wrote a commentary on the study, but was not involved in the research.

She says the requirement to fast before a cholesterol test was based on very small studies where researchers fed subjects very high-fat or high-sugar meals.

"Most people aren't having big fat loads before they get their lipids measured," she says.

Currently, guidelines still recommend that people not eat before a cholesterol test. But Mora says a growing body of evidence suggests that fasting isn't necessary.

"We've had several studies now that have all found the same thing," she says.

SOURCES: Sidhu, D. Archives of Internal Medicine, Nov. 12, 2012. Khera, A. Archives of Internal Medicine, Nov. 12, 2012. Gaziano, J. Archives of Internal Medicine, Nov. 12, 2012. Christopher Naugler, MD, MSc, chief of clinical pathology, University of Calgary, Canada. Suzanne Steinbaum, MD, preventive cardiologist, Lenox Hill Hospital, New York City. Samia Mora, MD, assistant professor of medicine, preventive cardiologist, Brigham and Women's Hospital, Boston.

©2012 WebMD, LLC. All Rights Reserved.

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Good Cholesterol Infusion May Help Unclog Arteries

By Charlene Laino
WebMD Health News

Reviewed by Louise Chang, MD

Nov. 5, 2012 (Los Angeles) -- An IV infusion of "good" HDL cholesterol seems to rapidly remove cholesterol out of plaque-clogged arteries following a heart attack, a small, early study suggests.

The goal of the new treatment is to reduce the high risk of a second heart attack in people who have had a heart attack.

In the year after a heart attack, about 12% of people have a second heart attack or stroke. And half of them happen in the first month, says researcher Andreas Gille, MD, PhD. Gille is head of clinical and translational science strategy at CSL Limited (which funded the study) in Parkville, Australia.

Standard heart attack medications, such as aspirin and anti-clotting drugs, prevent clotting but don't eliminate an underlying factor: cholesterol that has built up on artery walls, he says.

HDL removes cholesterol from artery walls, but current HDL-boosting drugs, such as niacin and fibrates, take years to work, according to Gille.

Gille and colleagues tested CSL112, an infusible and natural human formulation of apolipoprotein A-1 (ApoA-1), in 57 healthy volunteers.

ApoA-1 is the key protein in HDL particles that transports cholesterol from arteries and other tissues into the liver for disposal. Think of it as a garbage truck: It picks up the debris and disposes of it at the dump.

Following a single infusion of CSL112, researchers looked for signs of cholesterol movement. Over the next two hours:

Cholesterol removal from cells rose 164%.Levels of ApoA-1 doubled. In contrast, levels of ApoA-1 only rise about 3% in the four weeks after niacin is given, Gille says.

There were no serious side effects.

Robert Eckel, MD, of the University of Colorado Health Sciences Center, says the strategy "is potentially useful. The question is, how important is it to address HDL levels quickly vs. treating them long-term.

"We still don't know enough about HDL to know how to modify it to best benefit patients," Eckel says.

The findings were presented here at the American Heart Association's Scientific Sessions 2012.

The next step is a larger study in which CSL112 will be given as a short series of weekly IV infusions shortly following a heart attack or heart-related chest pain.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES: American Heart Association Scientific Sessions 2012, Los Angeles, Nov. 3-7, 2012. Andreas Gille, MD, PhD, head, clinical and translational science strategy, CSL Limited, Parkville, Australia. Robert Eckel, MD, University of Colorado Health Sciences Center.

©2012 WebMD, LLC. All Rights Reserved.

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Gene-Tweaked Tomatoes, Probiotics Aim to Lower Your Cholesterol

By E.J. Mundell
HealthDay Reporter

MONDAY, Nov. 5 (HealthDay News) -- People who took a probiotic supplement containing a beneficial bacteria saw their cholesterol levels improve, and a freeze-dried concoction made from a genetically engineered tomato had a similar effect on mice, two new studies show.

The research, to be presented Monday at the American Heart Association annual meeting in Los Angeles, is the latest to use nonpharmaceuticals or specially designed foods to rein in high cholesterol -- a major risk factor for heart disease, heart attack and stroke.

In one study involving 127 people with high cholesterol, those who took a twice-daily supplement of a special strain of the Lactobacillus reuteri bacterium for nine weeks experienced an average 11.6 percent drop in LDL "bad" cholesterol and a 9.1 percent drop in total cholesterol, compared to those taking a placebo.

Other strains of L. reuteri are found naturally in breads and yogurts, but researchers at the Canadian probiotics company Micropharma, which funded the study, say they've formulated a strain that seems to help block the absorption of cholesterol.

The strain, called L. reuteri NCIMB 30242 and marketed as Cardioviva, is thought to help break up bile salts, which helps lower absorption of cholesterol.

Dr. Mitchell Jones, chief scientific officer at Micropharma, helped develop the product, which he said can also be added to food products such as yogurts. "Cardioviva is a novel, natural approach to one of the most prevalent heart problems of our time, high cholesterol," Jones said. As to safety, he added that, "like other probiotics, if there are gastrointestinal side effects, they are rare and usually minor."

According to Jones, Micropharma plans to launch Cardioviva in supplement form in Canada early in 2013, and "in the U.S. market we are working to launch the supplement a little later on in 2013, maybe by the fall."

One heart expert said that products such as Cardioviva might help reduce cholesterol, but they should be seen as just one added weapon in the battle against heart disease.

"As a well-tolerated substance, and easily taken at a lower dose than other supplements, Lactobacillus may be a beneficial supplement in reducing cholesterol," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City.

However, she said that any effective attempt to lower cholesterol should always involve healthy diet and exercise.

A second study looked at a genetically engineered tomato that produces a peptide (a type of protein) that mimics the effect of HDL "good" cholesterol when eaten.

The study involved mice that were specially bred to have uncontrolled LDL "bad" cholesterol. The mice were fed a high-calorie, fatty "Western"-style diet plus a freeze-dried, ground version of the genetically tweaked tomato for two weeks. The tomato powder made up 2.2 percent of the rodents' total diet.

The researchers, led by Dr. Alan Fogelman, chair of the department of medicine at UCLA's David Geffen School of Medicine in Los Angeles, said that mice given the powder displayed lower blood levels of inflammation, higher levels of good cholesterol and less signs of atherosclerotic plaques ("hardening of the arteries"), among other signs of improving cardiovascular health.

"We have found a new and practical way to make a peptide that acts like the main protein in good cholesterol, but is many times more effective and can be delivered by eating the plant," Fogelman, who is also director of the Atherosclerosis Research Unit at UCLA, said in an AHA news release.

The study was funded by the U.S. National Heart, Lung and Blood Institute.

Reviewing the data, cardiologist Steinbaum said, "Although interesting, a mice trial like this cannot necessarily be extrapolated to the choices that human beings make, in terms of the foods that they eat."

And she warned against hoping for too much from research into "medicinal foods."

"Based on this trial alone in mice, the concept of 'medicinal' genetically engineered foods are not the do-it-yourself pharmacies of the future," Steinbaum said.

A smarter, old-fashioned choice would be simply to eat more healthily, she added.

"We know that a diet rich in fruits and vegetables and multi-grains, and low in fats, can also decrease the incidence of heart disease in humans," Steinbaum said. "Yet the Western diet filled with fat and simple sugars still is more preferred."

Experts also note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Mitchell Jones, Ph.D., M.D., chief scientific officer and co-founder, Micropharma, Montreal; Suzanne Steinbaum, M.D., preventive cardiologist, Lenox Hill Hospital, New York City; Nov. 5, 2012, presentation, American Heart Association annual meeting, Los Angeles

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New Drug to Lower 'Bad' Cholesterol Shows Promise

By Kathleen Doheny
WebMD Health News

Reviewed by Louise Chang, MD

Nov. 14, 2012 -- Adding an experimental biologic drug to a course of statin drugs can help lower LDL "bad" cholesterol even more, according to new research.

"These drugs actually start where statins finish," says Evan Stein, MD, PhD, director of the Metabolic & Atherosclerosis Research Center in Cincinnati.

Known as REGN727/SAR236553, the drug is a monoclonal antibody, a type of biologic. A biologic is created through a biological process instead of chemically synthesized.

Stein compared the effects of taking Lipitor (atorvastatin) along with either injections of the new monoclonal antibody or a placebo injection. He tested it in patients who still had high LDL levels despite taking a starting dose of Lipitor for at least seven weeks.

The study was funded by Sanofi and Regeneron Pharmaceuticals, which make the new biologic. It is published in the New England Journal of Medicine.

Although the results look promising, long-term studies are still needed, says Raymond J. Gibbons, MD. Gibbons is professor of medicine at Mayo Clinic, in Rochester, Minn. He was not involved in the study.

Statins can help lower cholesterol in many people, Stein says. But they don't work well for everyone.

"About 10% to 20% of patients cannot tolerate statins or high enough doses to get [their cholesterol] under control," he says.

LDL levels below 100 milligrams per deciliter are recommended for people with established heart disease. Those at highest risk should aim for levels under 70.

The new drug inhibits a protein called PCSK9. In the process, it allows for the removal of LDL from the blood.

Stein's team studied the new drug in 92 patients. Their average age was in the mid- to late-50s. All had LDL levels above 100 even after taking 10 milligrams of Lipitor for at least seven weeks.

He assigned patients to one of three groups for eight weeks:

80 milligrams of Lipitor daily, plus injections of the new drug every two weeks10 milligrams of Lipitor a day, plus injections of the new drug every two weeks80 milligrams of Lipitor daily, plus placebo injections every two weeks.

"It's a little injection in the abdomen, under the skin," Stein says.

The researchers followed the patients for eight more weeks.

All those who got the new biologic lowered their cholesterol below 100.

But only 52% of those who got 80 milligrams of Lipitor but placebo injections lowered their LDL below 100.

"More than nine out of 10 of those who got the new drug lowered their LDL to below 70, regardless of whether the statin dose was 10 or 80 milligrams," Stein says.

Only 17% of those who got the higher dose of Lipitor and placebo injections reduced their LDL levels below 70.

The side effects were similar among the three groups. Some patients reported headache, dizziness, diarrhea, or other gastrointestinal problems or musculoskeletal problems.

However, Stein says, the study was fairly short term, "especially for drugs that will likely be taken life-long." And larger studies are needed.

He says it is too early to estimate the cost of the new drug.

He reports consulting fees from Amgen, Adnexus Therapeutics, Genentech, Regeneron, and Sanofi related to PCSK9 inhibitors. His institution has received research funds directly related to PCSK9 clinical trials and lab analysis from Alnylam, Amgen, BMS, Genentech, Sanofi, and Regeneron.

Long-term data are needed and critical for further understanding, Gibbons says.

The need to inject the drug may not appeal to some patients, he says. "The inconvenience would be a barrier to many patients, particularly to those who don't have their own transportation."

Researchers need to examine whether the new drug results in fewer heart attacks and strokes.

Sanofi and Regeneron Pharmaceuticals are recruiting people for additional studies.

Amgen and other companies are also developing PCSK9 protein inhibitor drugs.

SOURCES: Evan Stein, MD, PhD, director, Metabolic and Atherosclerosis Research Center; professor of pathology and laboratory medicine, University of Cincinnati. Roth, E. New England Journal of Medicine, Nov. 15, 2012. Raymond J. Gibbons, MD, Arthur M. and Gladys D. Gray professor of medicine, Mayo Clinic, Rochester, Minn.

©2012 WebMD, LLC. All Rights Reserved.

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Generic Lipitor Recall

By Daniel J. DeNoon
WebMD Health News

Reviewed by Louise Chang, MD

Nov. 26, 2012 -- Ranbaxy Pharmaceuticals Inc., a major maker of generic Lipitor, has issued a massive recall of the cholesterol-cutting tablets, which may be contaminated with tiny glass shards.

The recall covers 41 lots of atorvastatin, the generic version of Lipitor. Each lot contains thousands of pills.

The recall includes 10 mg, 20 mg, and 40 mg dosages. It does not include 80 mg atorvastatin tablets.

No injuries have been reported from the "small glass particles approximately less than 1 millimeter in size."

Ranbaxy says it is "proactively recalling the drug product lots out of an abundance of caution, and in keeping the safety of our customers in mind."

Ranbaxy, an Indian firm, is owned by Japan's Daiichi Sankyo Co. According to The Wall Street Journal, Ranbaxy's generic Lipitor makes up 44% of the U.S. market for atorvastatin, including generic and name-brand products.

Earlier this year, Ranbaxy entered into a consent decree with the U.S. Justice Department preventing the company from selling various generic drugs on the U.S. market until it addresses manufacturing and quality-control flaws at several plants. Those plants did not make the generic Lipitor now being recalled.

The FDA is working with other atorvastatin makers to prevent a shortage of the popular cholesterol-lowering pills.

"The FDA is currently working with the other manufacturers to address any potential shortage as a result of the ongoing recall. We are monitoring the situation," FDA spokeswoman Sarah Clark-Lynn says in an email.

A list of the recalled products, including lot and NDC numbers, is posted on the Ranbaxy web site.

SOURCES: News release, Ranbaxy Pharmaceuticals Inc. Ranbaxy web site. FDA web site. Sarah Clark-Lynn, FDA public information officer. Wall Street Journal web site, accessed Nov. 23, 2012.

©2012 WebMD, LLC. All Rights Reserved.

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New Drug May Help Those Who Can't Take Statins

MONDAY, Nov. 5 (HealthDay News) -- An experimental drug may help patients who can't tolerate statins lower their cholesterol, a new Australian study suggests.

The 12-week, phase 2 clinical trial was conducted at 33 international sites and included adults who suffered muscle problems when taking statins, a class of cholesterol-lowering drugs that includes Crestor and Lipitor. They received injections of a placebo or different doses of AMG145, which is a human monoclonal antibody.

Human monoclonal antibodies are naturally occurring human antibodies that are genetically altered in a laboratory, cloned in large numbers and introduced into the patient to target disease sites.

The patients who received AMG145 had 41 percent to 63 percent reductions in "bad" (LDL) cholesterol and did not experience significant muscle-related side effects, said study leader Dr. David Sullivan, of the Royal Prince Alfred Hospital in Australia, and colleagues.

The reductions in LDL cholesterol seen in these patients were comparable to those that occur in patients taking the highest doses of the most effective statins, the researchers added.

One expert found the results intriguing.

"The most interesting aspect of this study is use of a novel approach using monoclonal antibodies -- a subtype of antibodies -- in the management of elevated LDL cholesterol," said Dr. Kenneth Ong, acting chief of cardiology at the Brooklyn Hospital Center.

"In this phase 2 study, the results are certainly impressive and warrant further investigation," Ong said. "Of note is the reduction in the number of myalgias (muscle pains) for patients compared to the number of myalgias experienced by people taking statins. If larger trials and longer durations of observation confirm these initial findings, many patients whose LDL cholesterol are otherwise untreated or under-treated could benefit."

Another expert agreed.

"For those patients with elevated LDL who are intolerant to statins, this provides a viable option," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City. More trials need to be done of this unique treatment, she added.

The study was published online Nov. 5 in the Journal of the American Medical Association, to coincide with a planned presentation at the American Heart Association's annual meeting in Los Angeles.

-- Robert Preidt Copyright © 2012 HealthDay. All rights reserved. SOURCES: Kenneth Ong, M.D., acting chief, cardiology, The Brooklyn Hospital Center; Suzanne Steinbaum, M.D., preventive cardiologist, Lenox Hill Hospital, New York City; Journal of the American Medical Association, news release, Nov. 5, 2012

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Statins Plus Exercise Best at Lowering Cholesterol, Study Finds

By Steven Reinberg
HealthDay Reporter

TUESDAY, Nov. 27 (HealthDay News) -- People who exercise along with taking statins to lower their high cholesterol levels can dramatically reduce their risk of dying, a large new study suggests.

"The reduction in death is independent; whatever statins do is independent of what exercise does," said lead researcher Peter Kokkinos, a professor in the cardiology department at the Veterans Affairs Medical Center in Washington, D.C.

"When you combine the two, you get even better results," he said. "If you are taking statins, your mortality is about 35 percent lower versus not taking statins, but if you exercise, your mortality level decreases as your fitness level increases to the point where you can reach a 70 percent reduction in mortality."

Kokkinos is talking about regular moderate exercise -- not vigorous workouts. "Thirty minutes a day of brisk walking -- not a whole lot," he said.

Statin drugs include Lipitor (atorvastatin), Lescol (fluvastatin), Pravachol (pravastatin), Crestor (rosuvastatin) and Zocor (simvastatin).

Some people can't take statins because of side effects, Kokkinos said. "For these people, exercise alone reduces your risk just as much, if not more, than statins," he said. However, he stressed, "we do not recommend that people do not take their statins."

Exercise works by stressing the body making it stronger, Kokkinos said. It's an evolutionary adaptation to protect the body from being overcome by changing stressors, he said.

"Get off the couch -- walk," Kokkinos said. "About 150 minutes a week of brisk walking is all you need."

The report was published online in the Nov. 28 edition of The Lancet.

For the study, Kokkinos' team analyzed the medical records of more than 10,000 veterans with high cholesterol levels treated in Veterans Affairs hospitals in Washington D.C., and Palo Alto, Calif. Of these, 9,700 were men and 343 were women.

The researchers judged the fitness levels of the participants by looking at the results of standard treadmill exercise tolerance tests, which were given between 1986 and 2011.

Fewer deaths occurred among participants who were taking statins and were physically fit. Over 10 years of follow-up, those who were the most physically fit had the lowest risk of dying, the researchers noted.

These fittest people actually reduced their risk of dying by about 60 percent regardless of whether they were taking statins, according to the study.

These difference in death risk could not be explained by age, weight, ethnicity, gender, history of cardiovascular disease, risk factors for cardiovascular disease or medications, the researchers said.

According to the U.S. Centers for Disease Control and Prevention, about 71 million Americans have high cholesterol, which is an important risk factor for heart disease, the authors pointed out.

One expert familiar with the new findings cautioned that exercise is not a replacement for statins in those with high cholesterol. The best results are among those taking statins and who are the fittest, he emphasized.

"Cardiovascular disease remains the leading cause of death and disability in men and women in the United States," said Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles.

"Statin therapy has been proven in multiple clinical trials to substantially reduce cardiovascular events and all-cause mortality in men and women with or at risk for cardiovascular disease," he said.

Some people have assumed that if they are engaging in regular exercise and are physically fit that they may not benefit from statin treatment and some physicians consider statin therapy only for patients who have failed attempts at lifestyle modification, Fonarow said.

This new study shows that at all levels of physical fitness, statin therapy was independently associated with lower risk of dying. The very best 10-year outcomes were among men and women taking statins with the highest fitness levels, he noted.

"These findings further reinforce the remarkable real-world clinical effectiveness and safety of statin therapy to prevent and treat cardiovascular disease," Fonarow said.

Copyright © 2012 HealthDay. All rights reserved. SOURCES: Peter Kokkinos, Ph.D., professor, Veterans Affairs Medical Center, Washington, D.C.; Gregg Fonarow, M.D., spokesman, American Heart Association, and professor, cardiology, University of California, Los Angeles; Nov. 28, 2012, The Lancet, online

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Atorvastatin Recall FAQs

Q: What information can the FDA provide about Ranbaxy's voluntary recall of atorvastatin tablets?

A: Ranbaxy initiated this voluntary recall after the company determined there was a quality issue with certain lots of its atorvastatin product (10mg, 20mg, and 40mg dosage strengths of atorvastatin tablets). The FDA was notified of the voluntary recall and is working with the company to resolve its quality issues.

Due to this quality issue, Ranbaxy has decided to stop manufacturing atorvastatin until it has thoroughly investigated the cause of the glass particulates and remedied the problem. Based on the information from Ranbaxy and from the FDA's initial assessment, the possibility of adverse events related to the recalled product appear to be low, and if any adverse events are experienced, they would be temporary.

Q: Has the FDA received any adverse events or injury reports from patients who have taken recalled atorvastatin?

A: At this time, we have not received any reports of patient harm due to glass particulates that may be in the recalled product.

Q: What is the risk to patients who have taken the recalled atorvastatin? Are there symptoms patients should be aware of?

A: Based on the information the company has provided, there is a remote possibility of patients experiencing adverse events after consuming the recalled product. However, at this time, we have not received any reports of patient harm.

Any patients who are concerned that they may have received recalled product should stop taking the product and consult with their pharmacist to confirm whether they received recalled product and to learn how to obtain alternative product.

Any patients who are experiencing any adverse event that they are concerned might be associated with taking recalled product should stop taking the product and contact their health care provider. Adverse events can be reported to the FDA through our MedWatch system:

Complete and submit the report online at www.fda.gov/MedWatch/report.htm, or download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178.

Q: Will there be a drug shortage of atorvastatin tablets?

A: The FDA does not anticipate a drug shortage. The FDA has consulted with other manufacturers of approved atorvastatin tablets and these manufacturers have indicated that they will be able to meet market demand.

Q: Where can I find the recalled product numbers?

A: The recalled products can be found here.

SOURCES:

FDA.gov. Questions and Answers on the Ranbaxy Atorvastatin Recall.

FDA.gov. FDA Statement on the Ranbaxy Atorvastatin Recall.

Last Editorial Review: 11/29/2012 6:08:43 PM

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Firm Stops Making Generic Lipitor After Recall

By Daniel J. DeNoon
WebMD Health News

Reviewed by Louise Chang, MD

Nov. 30, 2012 -- After recalling 41 lots of its generic Lipitor -- atorvastatin -- the FDA says Ranbaxy Inc. will stop making the drug "until it has thoroughly investigated" how glass particles got into the medication.

Although Ranbaxy supplied more than 40% of the generic cholesterol-lowering drug sold in the U.S., the FDA says it does not expect a shortage. Five other firms make generic Lipitor: Sandoz, Teva, Apotex, Mylan, and Dr. Reddy's.

The FDA says the tiny glass particles contaminating Ranbaxy's atorvastatin have only "a remote possibility" of causing harm. Ranbaxy says the particles, about the size of a grain of sand, might cause "physical irritation."

Ranbaxy makes atorvastatin, and puts it into pill form at its U.S. facilities. The active ingredient, however, comes from India. Ranbaxy's preliminary investigation suggests that this active ingredient was contaminated with the glass particles, according to FDA public information officer Sarah Clark-Lynn.

To date, there have been no reports of harm linked to Ranbaxy generic Lipitor.

It's not the first sign of trouble for Ranbaxy, the huge Indian pharmaceutical company owned by Japan's Daiichi Sankyo. Last January, the company signed an FDA-requested consent decree closing plants in India and the U.S. until it made "fundamental changes." None of those plants made the recently recalled generic Lipitor products.

The company admitted to several serious charges, including submitting false data to the FDA, failing to prevent contamination of sterile drugs, failing to prevent penicillin contamination of non-penicillin drugs, and inadequate testing of drugs to ensure they kept their potency until their expiration date.

The U.S. Justice Department said the action was "unprecedented in its scope."

The recalled atorvastatin comes as a white tablet packaged in plastic bottles. The 10-mg tablets bear the imprint "RX12," the 20-mg tablets bear the imprint ''RX828," and the 40-mg tablets bear the imprint "RX829." No 80-mg tablets are included in the recall.

Here's the list of the recalled atorvastatin products:

ATORVASTATIN Calcium Tablets 10mg x 90ATORVASTATIN Calcium Tablets 10mg x 90ATORVASTATIN Calcium Tablets 10mg x 90ATORVASTATIN Calcium Tablets 10mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 20mg x 90ATORVASTATIN Calcium Tablets 40mg x 500ATORVASTATIN Calcium Tablets 40mg x 500ATORVASTATIN Calcium Tablets 40mg x 500ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90ATORVASTATIN Calcium Tablets 40mg x 90SOURCES: News release, FDA. FDA web site. Department of Justice web site. Ranbaxy web site.

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Juxtapid Approved for LDL Cholesterol Condition

WEDNESDAY, Jan. 2 (HealthDay News) -- Juxtapid (lomitapide) has been approved by the U.S. Food and Drug Administration to treat a rare inherited disorder in which the body is unable to remove low-density lipoprotein (LDL) "bad" cholesterol from the blood.

Homozygous familial hypercholesterolemia (HoFH) affects about 1 million people in the United States, the agency said in a news release. The inability to remove LDL cholesterol from the blood often causes heart attacks and death before age 30, the FDA said.

Juxtapid, a once-daily capsule, is meant to be taken without food at least two hours before the evening meal, the agency said.

The drug was evaluated in a clinical study of 29 people with HoFH, causing a drop in LDL levels of about 50 percent in 26 weeks among those who tolerated the treatment. The drug's label carries a boxed warning of the potential for serious liver poisoning and progressive liver disease, the FDA said.

The most common clinical side effects noted were diarrhea, nausea, vomiting, indigestion and abdominal pain.

Juxtapid is marketed by Aegerion Pharmaceuticals, based in Cambridge, Mass.

-- Scott Roberts Copyright © 2013 HealthDay. All rights reserved.

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Drug OK'd for Deadly Genetic Condition Tied to Cholesterol

WEDNESDAY, Jan. 30 (HealthDay News) -- Kynamro (mipomersen sodium) has been approved by the U.S. Food and Drug Administration to treat a rare inherited condition in which the body can't remove low-density lipoprotein (LDL) cholesterol from the blood.

LDL is the so-called "bad" cholesterol that can clog the arteries and cause heart attack and stroke. Many people with homozygous familial hypercholesterolemia (HoFH) have a heart attack and die before age 30, the FDA said in a news release.

HoFH affects approximately one of every 1 million people in the United States. Kynamro is a once-weekly injection designed to lower creation of blood lipid particles that ultimately form LDL, the agency said.

The drug was clinically evaluated among 51 people with HoFH. Among Kynamro users, LDL levels fell an average of about 25 percent during the first 26 weeks, the FDA said. The drug will carry a "black box" label warning of possible liver abnormalities that could lead to progressive liver disease.

More common side effects noted during clinical testing included injection-site reactions, flu-like symptoms, nausea, headache and elevated liver enzymes.

Kynamro is produced by Genzyme Corp., of Cambridge, Mass.

-- Scott Roberts Health News Copyright © 2013 HealthDay. All rights reserved.

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