University Health System

4502 Medical Drive
San Antonio, TX 78229
P 210.358.4000
www.universityhealthsystem.com

uhs

University Health System Overview

University Health System is a nationally recognized academic medical center. Thanks to its partnership with UT Medicine San Antonio, it has positioned itself as a leader in advanced treatment options, new technologies and clinical research.

For 2012-2013, U.S. News & World Report ranked University Hospital as the best regional hospital in the San Antonio metro area. In addition, University Health System is the first health organization in Bexar County and South Texas to earn Magnet® status – a recognition from the American Nurses Credentialing Center (ANCC) granted to only about six percent of U.S. hospitals.

University Hospital currently operates 496 beds, and is the lead Level I trauma center for all of South Texas. It is also the only pediatric trauma center recognized by the American College of Surgeons, able to provide expert trauma care for critically injured and burned children. Centers of excellence include Organ Transplantation, Cardiovascular Disease and Neurosciences.

University Health System is expanding to meet the needs of San Antonio and South Texas’ growing community through its Capital Improvement Program (CIP). The expansion project includes a new, ten-story, one million-square-foot tower at University Hospital that will open in early 2014. A new 269,000-square-foot Clinical Pavilion on the Robert B. Green Campus downtown opened in January 2013, offering patients expanded primary and urgent care services to include a new PediExpress. The Clinical Pavilion is home to over 100 specialists and state-of-the-art technology including enhanced imaging and an outpatient surgery center opening in May, 2013.

University Featured Video

Neuroscience Articles

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.

  • Pfizer meningitis vaccine wins U.S. approval

    By Reuters Staff

    (Reuters) - Pfizer Inc has won U.S. approval for its Trumenba vaccine against meningitis, a potentially deadly bacterial disease that has recently caused outbreaks on college campuses, the U.S. Food and Drug Administration said on Wednesday.

    Trumenba, approved in individuals 10 to 25 years of age, has been considered one of the most important products in Pfizer's drug pipeline. It was granted accelerated approval following tests in 4,500 people in the United States, Europe and Australia.

    It is the first approved U.S. vaccine that prevents invasive disease caused by the bacterium Neisseria meningitidis B, a strain that causes disease globally in an estimated 20,000 to 80,000 people a year, and accounts for an estimated 40 percent of meningitis infections in the United States, according to Pfizer.

    Meningitis can be treated with antibiotics, but 10 to 15 percent of patients die and up to 19 percent of survivors have long term disabilities, including brain damage and limb amputations. Vaccination is deemed the best way to prevent the disease.

    Pfizer and Swiss drugmaker Novartis had both won the FDA's coveted "breakthrough therapy" designation for their rival meningitis B vaccines and were racing for the first FDA approval.

  • Experts update stroke prevention guidelines

    By Andrew M. Seaman

    (Reuters Health) - Tools for preventing strokes include a healthy diet, home blood pressure monitoring and an online stroke-risk estimator, according to updated guidelines issued Wednesday by a leading heart health organization.

    Together with traditional measures like smoking cessation aids, medications and surgeries, the updated recommendations can help people substantially reduce the risk of stroke, said Dr. James Meschia, who led the group that wrote the new guildelines for the American Heart Association/American Stroke Association.

    "(Stroke is) not like one of those many conditions we have that there is no way to prevent it," Meschia told Reuters Health by phone.

    About 796,000 U.S. adults have a stroke each year, the group writes in the journal Stroke. More than three quarters of these are first-time strokes.

    The most common form of stroke occurs when blood flow is blocked in part of the brain, usually by a clot. Another form happens when a blood vessel breaks, hemorrhaging blood into the brain.

    Nationally, strokes are the fourth leading cause of death. People who do not die from strokes may be left immobile and dependant on others for care.

    "Clearly treating stroke is very difficult," said Dr. Gregory Albers. "If you can prevent the stroke, it's much better," added Albers, who was not part of the guidelines group but directs the Stanford Stroke Center in California.

    A 2010 study found that 90 percent of stroke risk is tied to risk factors, such as high blood pressure, overweight and smoking. While controlling those factors won't eliminate stroke risk, it can substantially reduce it, said Meschia, who is also chair of neurology at the Mayo Clinic in Jacksonville, Florida.

    The guidelines, which were last updated in 2011, focus on what can be done to prevent a first-time stroke.

    "Some of it isn't as new because it's pulling together guidelines from other areas," said Dr. Andrew Russman, who also wasn't involved in updating the guidelines but is a stroke expert from the Cleveland Clinic in Ohio.

    For example, the new guidelines recommend use of an online tool that estimates a person's risk of stroke over the next 10 years based on race, gender, age, cholesterol, blood pressure, diabetes and smoking. (More information is available here: http://bit.ly/1uGpcMK.)

    The tool was announced in conjunction with other guidelines last year and sparked controversy (see Reuters story of Nov 18, 2013 here: http://reut.rs/102ieol). Some doctors feared it would put too many people on cholesterol-lowering statin drugs.

    The updated guidelines say statins should be used in addition to diet and exercise among people with a high risk of stroke over the next 10 years.

    The guidelines also recommend new blood-thinning medications to reduce the risk of stroke among people with atrial fibrillation, an abnormal heart rhythm that can cause blood clots.

    Meschia said the newer medications require less monitoring than older blood-thinners and may have other advantages, such as a reduced risk of brain bleeds.

    "From that point of view - at least for the general population with atrial fibrillation at risk for stroke - they present a new option," he said.

    The guidelines also advise that people cut back on sodium and consume more potassium to lower blood pressure, and they recommend either a Dietary Approaches to Stop Hypertension (DASH) diet or a Mediterranean-style diet.

    Mediterranean-style diets include a lot of fruit, vegetables and whole grains as well as fish, olive oil and nuts, but limit unhealthy fats. Mediterranean-style eating has been linked to lower risks of heart disease - possibly through reduced blood pressure.

    "Clearly blood pressure - for stroke - is the number one risk factor," Albers said. "A lot of the stroke specialists like to see blood pressure down to 120 over 80."

    Meschia agreed and said the new guidelines also recommend that people monitor their own blood pressure - not just wait for it to be measured at the doctor's office.

    "If you had to do one thing and do one thing only, it's know your pressure and keep it down," he said.

    Russman said the risk factors addressed by the new guidelines are important and controlling them early enough may prevent strokes.

    "I think it stressed the importance of eating a healthy diet - like a Mediterranean diet - and the benefit of regular exercise and follow up with a primary care physician to identify problems early when they arise, so we can initiate lifestyle and medication interventions early to prevent future problems," Russman said.

    SOURCE: http://bit.ly/102rXe9 Stroke, online October 29, 2014.

  • Oregon, Alaska, D.C. voters to weigh legal marijuana in November

    By Andy Sullivan

    WASHINGTON (Reuters) - Voters in the U.S. capital and two West Coast states will decide in the Nov. 4 elections whether to legalize marijuana, pushing closer to the mainstream a notion that was once consigned to the political fringe.

    Ballot initiatives in Oregon and Alaska would set up a network of regulated pot stores, similar to those already operating in Colorado and Washington state. A measure in the District of Columbia would allow possession but not retail sales.

    If successful, the ballot initiatives could build momentum for legalization in other states and force candidates in the 2016 presidential election to take a stand on the issue.

    Public opinion on marijuana has shifted sharply in the past several years, and polls indicate more Americans now support legalization than oppose it. Advocates say that, like gay marriage, legal pot is an idea that gains support once people see it in action.

    "The more public dialogue that goes on about this issue, the more support there is," said Mason Tvert of the Marijuana Policy Project, which is supporting the legalization drive in Alaska.

    Opponents say legalization will create an aggressive new industry that, like the tobacco business, will profit by marketing an addictive product to teens. Unlike gay marriage, legal pot will have harmful effects, many say.

    "I don't know anybody who looks around and says, 'My life is better when everybody around me is stoned,'" said Kevin Sabet, a former White House drug-policy adviser who now heads up Smart Approaches to Marijuana, an anti-legalization group.

    Few elected officials in the country support legalization and observers do not expect that to change any time soon.

    "It seems that this is an area where the public is out in front of their elected officials," said Jake Weigler, an Oregon Democratic strategist not affiliated with the legalization effort.

    So for the moment advocates are focused on ballot initiatives. Such referendums allow voters to shape policy directly at the state level: this year alone, ballots in various states include measures to raise the minimum wage, restrict abortion and ban certain types of bear hunting.

    On the marijuana issue, voters in the District of Columbia back legalization by a two-to-one margin, according to recent polling, while a narrow majority supports legal pot in Oregon. Opinion polls in Alaska have been inconsistent.

    Nationwide, roughly one in four Americans say they have used pot, according to Reuters/Ipsos polling. Some 47 percent support legalization and 35 percent oppose it.

    Marijuana remains illegal under federal law, but President Barack Obama has allowed Colorado and Washington to move forward with legalization. Federal prosecutors have been told to focus enforcement on areas such as interstate trafficking and selling to minors, rather than possession. The next president will have to decide whether to continue that approach or to insist that federal law trumps local concerns.

    CHANGES OVER TWO DECADES

    Marijuana has been edging toward legal status across the country since California became the first state to allow its use for medical purposes in 1996.

    The medical use of marijuana, to ease ailments ranging from glaucoma to chronic pain, is now legal in 23 states and the District of Columbia. Florida may become the first state in the South to approve medical pot in November.

    Some 18 states have also removed criminal penalties for possession of small amounts, as policymakers on the left and the right have questioned the social and fiscal costs of imprisoning nonviolent drug users. Nationwide, about 650,000 people were arrested for marijuana possession in 2012, FBI statistics show.

    Colorado and Washington opened the first state-licensed pot stores earlier this year, following legalization referendums in 2012.

    Beau Kilmer, a drug policy expert at the RAND Corporation, a nonpartisan think tank, said it is too soon to determine how those efforts are faring because there is not enough data to determine whether legalization has led to more crime, higher rates of underage use, or more people driving while high.

    Colorado residents are split on legalization's merits. Some 51 percent of likely voters in the state support it and 41 percent oppose it, according to Reuters/Ipsos polling.

    Opponents of legal marijuana are not like the anti-drug warriors of past decades. Many support decriminalization and medical use, if done carefully, but argue that other states should not be in such a hurry to follow Colorado and Washington all the way to legal pot shops.

    "I don't want to speak for the next couple of years, but right now it's not the right choice," said Charles Fedullo, a spokesman for Big Marijuana Big Mistake, which opposes the legalization drive in Alaska.

    Advocates have plenty of money to spend. In liberal-leaning Oregon, backers are spending $2 million on a prime-time TV ad campaign. Opponents, meanwhile, have raised a mere $168,000, largely from law-enforcement groups. In Alaska, a Republican-leaning state with a strong libertarian streak, backers have raised $867,000 while opponents have raised $97,000.

    "This is a real David versus Goliath operation. We're the David," said Josh Marquis, an Oregon district attorney involved in the anti-legalization campaign.

  • Joan Rivers' daughter hires law firm to investigate comedian's death

    By Reuters Staff

    LOS ANGELES (Reuters) - Melissa Rivers, the daughter of comedian Joan Rivers, has hired a New York law firm to investigate the circumstances behind her mother's death from a complication during an outpatient throat procedure, the firm said on Tuesday.

    The investigation could ultimately lead Melissa Rivers to file a civil lawsuit against the clinic where her mother was treated.

    "In order to fully determine the facts and circumstances surrounding the death of Joan Rivers, we confirm that our firm has been engaged by Melissa Rivers and her family," Ben Rubinowitz, a partner at Gair, Gair, Conason, Steigman, Mackauf, Bloom & Rubinowitz, said in a statement.

    Rubinowitz declined to comment further or say if Melissa Rivers intended to file a lawsuit.

    Rivers, 81, died in a hospital on Sept. 4, a week after she stopped breathing during an examination of the back of her throat and vocal cords at Manhattan's Yorkville Endoscopy.

    New York's medical examiner determined the brash comedian, who helped pave the way for women in comedy, died from anoxic encephalopathy, a condition caused when brain tissue is deprived of oxygen and there is brain damage.

    Following Rivers' death, the State Health Department launched an investigation into the clinic where Rivers was treated.

    Melissa Rivers co-hosted cable network E!'s series "Fashion Police" with her mother before her death.

Oncology Articles

  • Massachusetts town's plan to ban tobacco sales riles store owners

    By Ted Siefer

    LOWELL, Mass. (Reuters) - Store owners in a Massachusetts town proposing to bar the sale of all tobacco products objected to the proposal on Tuesday, a day after local officials announced the planned ban.

    Health officials in Westminster, about 60 miles (97 km)northwest of Boston, released a plan on Monday to bar the sale of cigarettes, chewing tobacco and cigars, as well as electronic cigarettes, citing health risks tied to the nicotine products.

    The Westminster regulation points to a ruling by the state's highest court holding that "the right to engage in business must yield to the paramount right of government to protect the public health by any rational means."

    Citing U.S. health authorities, the proposed regulation states that there is "conclusive evidence that tobacco smoking causes cancer, respiratory and cardiac diseases, (and) negative birth outcomes."

    Convenience store owners in the town of about 7,300 residents said the ban would do little to cut down on tobacco use and prompt customers to drive to the next town for the product while sharply cutting their stores' incomes.

    "It's not just the loss of tobacco sales," said Brian Vincent, the owner of Vincent's Country Store. "It's the additional impulse items smokers buy, a bottle of soda, a bag of chips for the road, scratch tickets."

    Vincent, who posted in his store a petition that had gathered 300 signatures by Tuesday morning opposing the ban, estimated that it would cost him $100,000 a year in sales.

    The New England Convenience Store Association has also taken a stand against the ban. "At the end of the day, it's businesses in the local community that will get hurt," said Stephen Ryan, the group's executive director.

    Westminster's health agent did not return requests on Tuesday for comment.

    While restrictions on smoking in specific settings have proliferated in Massachusetts and around the country, Westminster appears to be the first to consider a town-wide ban on the sale of all tobacco products.

    Historian Robert Proctor of Stanford University said he was unaware of a municipal ban on tobacco products in nearly a century.

    In Boston, a ban went into effect this year on smoking in all public parks and playgrounds.

    A three-member Westminster Board of Health will be required to vote to pass the ban.

    The board will hold a public hearing on the topic on Nov. 12.

  • Advanced ovarian cancer may someday be detected with tampons

    By Kathryn Doyle

    (Reuters Health) - In a small new study, ovarian cancer cells were detectable on the tampons of some women with advanced stage cancer.

    "This is a proof of principle study that certainly needs more work on it before we know how useful it will be," said Dr. Charles N. Landen Jr. of the University of Virginia, Department of Obstetrics and Gynecology.

    But it is helpful to know that you can pick up tumor DNA in vaginal secretions, Landen told Reuters Health by phone.

    Ovarian cancer is often diagnosed at a late stage, since there is no effective screening method for early-stage ovarian cancer. About 22,000 women are diagnosed with ovarian cancer in the U.S. each year, and almost 14,300 will die, according to the American Cancer Society.

    Landen and his coauthors studied eight women with advanced serous ovarian cancer, which is the most common form of ovarian cancer. Eight to 12 hours before surgery, they each inserted a commercially available tampon, which was removed in the operating room.

    All eight women had TP53 DNA mutations in their tumors, which is a very common mutation for this form of cancer, the authors write.

    Five of the women had intact fallopian tubes, while three had had tubal ligation surgery previously.

    Of the five women who did not have their "tubes tied," three had the exact same TP53 mutations detectable from their tampon samples, according to results published in the journal Obstetrics & Gynecology.

    Identifying three out of five, or 60 percent, of cancers is not bad, but not ideal for a disease as rare as ovarian cancer, Landen said.

    "It's not enough for us to have total confidence over its ultimate utility," he said.

    None of the women with tubal ligation had tumor mutations in their tampon samples.

    "We have no way of knowing whether or not the DNA we picked up originated in the fallopian tubes or in the abdominal cavity," but either way it does demonstrate that cancer happening elsewhere in the genital tract does affect the vaginal canal, Landen said.

    A previous study found similar tumor DNA detectable by Pap smear.

    This is not yet a breakthrough in detecting ovarian cancer, according to Paul Spellman, who researches the biology of cancer at Oregon Health & Science University in Portland, and was not involved in the study.

    "These findings are helping researchers move toward a method for screening for ovarian cancer," said Dr. Shannon N. Westin of the Department of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center in Houston. "This has certainly been a 'holy grail' for some time."

    Westin was not involved in the new study.

    "Thus far, imaging and serum tests have not been able to reliably detect ovarian cancer at an early stage," she told Reuters Health by email. "Ovarian cancer survival is significantly improved when detected at an early stage."

    Five years after diagnosis with stage 1 ovarian cancer, approximately 90 percent of women have survived, compared to approximately 35 percent for Stage IIIc, the most commonly diagnosed stage, she said.

    It is not clear if this kind of tampon screening would identify early-stage cancers of the ovaries or fallopian tubes, Landen said.

    This pilot study did identify some advanced cancers, and may be more useful some day as targeted screening for women at high risk, like those with a family history of ovarian cancer or those with the BRCA mutations, especially younger women who still want to have children and don't want their ovaries removed unless absolutely necessary, he said.

    Though this method of detection is a long way from actually being used to screen women for early stage ovarian cancer, it does have the advantage that it's relatively easy for women to do and doesn't involve surgery, he noted.

    SOURCE: http://bit.ly/ZTNTse Obstetrics & Gynecology, November 2014.

  • Canadian guidelines recommend against prostate cancer test

    By Andrew M. Seaman

    (Reuters Health) - Men should not get a common blood test to screen for prostate cancer, according to new healthcare guidelines from Canada.

    The potential for harm after prostate-specific antigen (PSA) testing outweighs the benefit, says the Canadian Task Force on Preventive Health Care.

    "The ratio seems to be on the harm side - not the benefit side," said Dr. Neil Bell, a member of the Task Force and chair of its prostate cancer screening working group.

    The Canadian group is part of a growing list of medical organizations that either question or don't recommend the test, which looks for elevated levels of a protein produced by the prostate gland.

    The government-backed U.S. Preventive Services Task Force does not recommend PSA screening for prostate cancer. Additionally, the American College of Physicians does not recommend PSA screening among men younger than age 50 and older than age 69. Also, it says men ages 50 to 69 should be told about the "limited potential benefits and substantial harms" of screening before being offered the test.

    Prostate cancer is the most common non-skin cancer among men and the third leading cause of cancer-related death among men, but the Task Force writes in the Canadian Medical Association Journal that the lifetime risk of prostate cancer death is only about 4 percent.

    "The most typical feeling most people have is, 'If I diagnose cancer early and I treat it, I get a better outcome,'" Bell said. "For prostate cancer, that doesn't hold for a number of reasons."

    Specifically, most prostate cancers would never cause men to die or feel sick, said Bell, who is also a family physician and professor at the University of Alberta in Edmonton.

    He and his colleagues write that about 70 percent of men between ages 70 and 79 are found to have undiagnosed prostate cancer after they die.

    The new guidelines are based on a review of medical evidence related to PSA testing.

    Overall, they found strong evidence showing that men would likely experience more harm than benefit from PSA screening if they're younger than 55 or older than 70.

    The researchers say that for every 1,000 men between ages 55 and 69 screened using PSA, one will be saved from death by the test.

    Of the other 999 who get screened by PSA, 720 will test negative. Of the 280 who will test positive, 178 will get additional testing - such as invasive biopsies - that ultimately show they don't have cancer.

    Of the 102 correctly diagnosed with prostate cancer by the PSA screening, 33 will be diagnosed with cancer that would not have caused them to become ill or die and end up with complications related to their treatment. Five men will die regardless of whether they get PSA screening.

    "Available evidence does not conclusively show that PSA screening will reduce prostate cancer mortality, but it clearly shows an increased risk of harm," they write. "The task force recommends that the PSA test should not be used to screen for prostate cancer."

    In an editorial, the University of Toronto's Dr. Murray Krahn argues that doctors should not take away the choice of PSA testing from men.

    "There clearly is not enough evidence to mount an organized screening program," he writes. "However, the falling overall mortality in some countries that screen intensively, the evidence that treatment may have a very modest disease-specific mortality benefit, and the highly variable preferences for treatment outcomes suggest to me that we should not push patients out of decision-making in this area."

    The Task Force does write in its recommendations that some men may place more value on a small reduction in the risk of death and not be as concerned with the possible harm of the screening. Those men may choose to be screened, they write.

    "There are some men who may want that benefit," Bell said.

    SOURCE: http://bit.ly/ZUJW6k and http://bit.ly/ZUJQvu CMAJ, online October 27, 2014.

  • U.S. envoy in West Africa to see how world failing in Ebola fight

    By Michelle Nichols

    CONAKRY (Reuters) - Guinea plans to fight its deadly Ebola outbreak by drafting graduating medical students for national service and enlisting retired doctors and nurses, said Samantha Power, U.S. Ambassador to the United Nations, during a visit to West Africa to see how the global response is failing to stop the deadly disease.

    Power, who will also visit Sierra Leone and Liberia, said she had a "very robust" discussion with Guinea's President Alpha Conde on Sunday about the way forward and that Conde has "tremendous impatience ... wholly appropriate to the cause."

    Conde told Power of ambitious plans to increase the number of Ebola Treatment Units (ETUs) across the country.

    "But it's a real mystery as to where the healthcare workers are going to come from to staff those ETUs," Power told Reuters.

    "So he described his own recruitment drive within Guinea in order to get medical students as they come out of their training to go right into Ebola treatment as a kind of national service, also to bring all the retired doctors and nurses back and conscripting them," she said.

    The three West African countries are bearing the brunt of the worst outbreak of the hemorrhagic fever on record, which the World Health Organization (WHO) says has killed nearly 5,000 people. A small number of cases have also been reported in Mali, Nigeria, Senegal, Spain and the United States.

    "We are not on track right now to bend the curve," Power told Reuters. "I will take what I know and I learn and obviously provide it to President Obama, who's got world leaders now on speed dial on this issue."

    "Hopefully the more specific we can be in terms of what the requirements are and what other countries could usefully do, the more resources we can attract," she said.

    The United Nations said last month almost $1 billion was needed to fight Ebola for the next six months. According to the U.N. Financial Tracking Service, nearly $500 million has been committed and $280 million in non-binding pledges made.

    "As we have seen, along with Spain, it is not a virus that is going to remain contained within these three affected countries if we don't deal with it at its source," Power said.

    Aid groups on the ground said more doctors, nurses and treatment centers were needed. Ebola patients were being turned away due to a lack of beds and were usually cared for at home, where they risked infecting more people, according to aid workers.

    Power also met with aid and other groups as well as leaders of the Muslim and Catholic communities.

    BED, MEDICAL STAFF SHORTAGES

    According to the Africa Governance Initiative (AGI), even if existing international commitments are met by December, there could be a shortage of over 6,000 beds across Sierra Leone and Guinea.

    Nearly half of the beds currently planned in the three countries will lack the medical staff needed to support them, a study by AGI, former British prime minister Tony Blair's London-based development consultancy found.

    AGI based its projections on the WHO's worst-case scenario, which forecast 10,000 new cases per week in December.

    "The international community badly misjudged the impact of the Ebola epidemic in its first few months and is compounding that error by failing to act quickly enough now," AGI Chief Executive Nick Thompson said.

    He called on more countries to follow the examples of the United States, Britain and Cuba, which have deployed military and medical personnel to the region to bolster efforts to stop the epidemic at its source.

    Some Republican lawmakers have called for a travel ban on the worst-affected countries after four cases of Ebola were diagnosed in the United States. New York, New Jersey and Illinois have imposed mandatory 21-day quarantines for health care workers coming from West Africa, even if they are not sick.

    Obama has resisted such a move on advice from public health officials who say Ebola, which is spread through contact with bodily fluids of an infected person, poses no major health threat to the country.

    Power said there was a risk these new measures could deter aid workers from traveling to West Africa to help.

    "We're in very close consultations with the states, we understand the legitimate fears," Power said. "We've got to find a way to address that fear, but we can't do so in a manner that undermines our ability to deal with the problem at its source."

    "We have to find the right balance in order to continue to attract health workers at the same time we try to address the fears of the healthcare workers neighbors when they come home," she said.

    Power said the benefits of seeing the Ebola response first hand outweighed the risks of traveling to Guinea, Liberia and Sierra Leone. She added that she would take all necessary precautions during her visit and upon her return to the United States, including checking her temperature "many times a day."

    Power also plans to visit the headquarters of the United Nations Ebola response mission in Ghana, which is coordinating efforts in West Africa.

  • U.S. officials considering quarantines for returning healthcare workers

    By Laila Kearney and Sebastien Malo

    NEW YORK (Reuters) - The Obama administration is considering quarantines for healthcare workers returning from Ebola-ravaged West African countries, an official said on Friday, as authorities in New York retraced the steps of a doctor with the disease.

    In Washington, President Barack Obama hugged a Dallas nurse who survived Ebola after catching it from a patient.

    Quarantining healthcare workers returning to the United States from the Ebola "hot zone" was one of a number of options being discussed by officials from across the administration, Tom Skinner, a spokesman for the Centers for Disease Control and Prevention (CDC), told Reuters.

    The CDC-led discussions began on Thursday after Dr. Craig Spencer tested positive for the disease that day after returning to New York from West Africa.

    Spencer, 33, a New Yorker who spent a month with the humanitarian group Doctors Without Borders working with Ebola patients in Guinea, was the fourth person diagnosed with the virus in the United States and the first in its largest city.

    He was awake and talking to family and friends on a cellphone and was listed in stable condition in Bellevue Hospital's isolation unit, said Dr. Mary Travis Bassett, New York's health commissioner. The CDC confirmed the diagnosis on Friday.

    Officials urged New Yorkers not to worry. Obama's embrace in the White House Oval Office with nurse Nina Pham, who was declared Ebola-free on Friday, seemed to underscore the message that the disease's threat was limited.

    Pham, one of two nurses from a Dallas hospital infected with Ebola after treating the first patient diagnosed with the disease in the United States, walked out smiling and unassisted from the Bethesda, Maryland hospital where she had been treated.

    Emory University Hospital in Atlanta and the CDC also confirmed that the other nurse, Amber Vinson, no longer had detectable levels of virus but did not set a date for her to leave that facility.

    Spencer finished his work in Guinea on Oct. 12 and arrived at John F. Kennedy International Airport in New York on Oct. 17.

    Six days later, he was quarantined at Bellevue Hospital with Ebola, unnerving financial markets amid concern the virus may spread in the city. The three previous cases diagnosed in the United States were in Dallas.

    New York City Mayor Bill de Blasio said city health department detectives were retracing all the steps taken by Spencer, but said the doctor poses no threat to others and urged New Yorkers to stick with their daily routines.

    "We are, as always, looking at each individual contact," he said.

    Health officials emphasized that the virus is not airborne but is spread through direct contact with bodily fluids from an infected person who is showing symptoms.

    Three people who had close contact with Spencer were quarantined for observation. The doctor's fiancée was among them and was isolated at the same hospital, and all three were still healthy, officials said.

    U.S. stock markets shook off Ebola fears on Friday after paring gains late on Thursday following initial reports about Spencer's case.

    The worst Ebola outbreak on record has killed at least 4,877 people and perhaps as many as 15,000, predominantly in Liberia, Sierra Leone and Guinea, according to the World Health Organization (WHO).

    Spencer's case brought to nine the total number of people treated for Ebola in U.S. hospitals since August. Just two, the nurses who treated Liberian national Thomas Eric Duncan, contracted the virus in the United States. Duncan died on Oct. 8 at Texas Health Presbyterian Hospital in Dallas, where Pham and Vinson were infected.

    Officials told New Yorkers they were safe even though Spencer had ridden subways, taken a cab and visited a bowling alley in Brooklyn between his return from Guinea and the onset of symptoms. Authorities on Friday declared the bowling alley safe.

    New York state Governor Andrew Cuomo said that unlike in Dallas, where the two hospital nurses treating Duncan contracted the disease, New York officials had time to thoroughly prepare and drill for the possibility of a case emerging in the city.

    "From a public health point of view, I feel confident that we're doing everything that we should be doing, and we have the situation under control," Cuomo said.

    LEAVING THE HOSPITAL

    Pham, who was transferred to the U.S. National Institutes of Health Clinical Center in Bethesda, Maryland, from the Dallas hospital on Oct. 16, appeared at a news briefing and thanked her doctors.

    Looking fit in a dark blazer and a turquoise blouse, Pham said that even though she no longer is infected, "I know that it may be a while before I have my strength back." She said she looked forward to seeing her family and her dog.

    White House spokesman Josh Earnest said Obama brought Pham in for a meeting to recognize her for doing her job at the Dallas hospital. Earnest said, "I think this also should be a pretty apt reminder that we do have the best medical infrastructure in the world."

    Photographs of the meeting showed Obama hugging Pham. Reporters and television cameras were not allowed in for the meeting.

    Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, said he could not pinpoint any one factor that contributed to Pham's speedy recovery. He said it could be any of a number of factors, including the fact that "she's young and very healthy" and was able to get intensive care very quickly.

    Pham received donated blood plasma from Dr. Kent Brantly, who contracted Ebola working in Liberia for a Christian relief group and survived after being treated with an experimental drug. Brantly was released from a hospital in August.

    It is believed that antibodies that fight the virus in the blood of Ebola survivors can help other patients fight it, too. Pham made a point of thanking Brantly upon her release.

    Cuomo said Spencer checked into the hospital when he realized he had a temperature of 100.3 degrees Fahrenheit, suggesting he may have caught the onset of symptoms early.

Orthopedic Articles

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.

  • Weak muscles can put diabetics at risk on stairs

    By Janice Neumann

    (Reuters Health) - When nerves in the legs and feet are damaged from diabetes, people often have trouble on stairs, but a new report suggests exercise might help lower their risk of falling.

    People with so-called diabetic peripheral neuropathy go up and down stairs more slowly and clumsily than healthy people because of weak muscles, sensory damage (loss of feeling) and poor coordination, say the authors of the report.

    Resistance exercises could help these individuals build up strength and avoid future falls, they wrote in the journal Diabetes Care.

    For people with diabetic peripheral neuropathy, falls "whilst walking down stairs are nearly unrecoverable," and as a result, account for a large proportion of fall-related deaths, said Joseph C. Handsaker of Manchester Metropolitan University in Manchester, UK, who led the research.

    "The aim of the study was to provide potential explanations for why patients with neuropathy are at a high risk of falling during the dangerous tasks of stair ascent and descent, in the hope that by identifying why falls occur, we can then suggest solutions for how to reduce the risk of falling," Handsaker told Reuters Health.

    An estimated 347 million people worldwide have diabetes, according to the World Health Organization. About half of patients with diabetes develop peripheral neuropathy after 10 years, Handsaker said.

    It's been known for a while that these patients have trouble on stairs, but the underlying reason hasn't been clear, Handsaker added.

    He and his colleagues compared 21 patients with diabetic neuropathy, 21 who had only diabetes, and 21 healthy individuals as they walked up and down a custom-built staircase.

    The researchers analyzed the electrical activity of participants' muscle tissue to determine when the muscles were "switched on and off" and when they reached peak activation.

    Overall, the patients with diabetic peripheral neuropathy were significantly slower at activating their knee and ankle muscles than the healthy group, and significantly slower at reaching peak knee-muscle activation.

    "The slower speed of strength generation is the key finding in this study, with alterations to muscle activation expected to contribute to the observed reductions," said Handsaker.

    For diabetics with peripheral neuropathy who'd like to strengthen their muscles and reduce their risk of falling, Handsaker suggested using isometric exercises like calf raises and knee extensions. Individuals should rapidly stretch these muscles for a second and then relax for three seconds, he said.

    His paper also advises that resistance training might be helpful, such as with weight machines, free weights or calisthenics.

    (Before starting to exercise, however, patients should get clearance from their doctors. As the American College of Sports Medicine advises, "Not all exercise programs are suitable for everyone, and some programs may result in injury.")

    Improving the strength and response of the extensor muscles will result in faster strength generation, which should improve stability during stair ascent and descent, said Handsaker.

    Dr. Michael Polydefkis, who directs the Johns Hopkins Cutaneous Nerve Laboratory and the Bayview EMG Laboratory and Diabetic Neuropathy Center, said he was glad to see a study that emphasized the effect of diabetes on people's ability to move around.

    He said people recognize the devastating effects of diseases like multiple sclerosis, Parkinson's and ALS but often don't realize how much diabetic neuropathy compromises quality of life.

    "Oftentimes peripheral neuropathy is not always given its due respect," said Polydefkis in a phone interview. "People don't really appreciate the impact this has on people's lives."

    Polydefkis, who was not involved in the study, said his patients typically complain of pain and numbness in their feet, rather than weakness. But the study showed that falls might be related to subtle muscle problems that aren't easy to detect. He often suggests balance exercises for his patients.

    Dr. Peter Dyck, who directs the Peripheral Nerve Research Laboratory at the Mayo Clinic in Rochester, Minnesota, told Reuters Health in a phone interview that the study helps confirm some of the reasons for the unsteady gait of diabetics. But Dyck, who was not involved in the study, said he wasn't convinced that exercise would help these individuals because of their sensory loss.

    "I think it's a worthwhile study, it was fun to read, but I'm not sure the take-home message is quite correct," said Dyck. "The emphasis needs to be on preventing polyneuropathy by good diabetic control."

    SOURCE: http://bit.ly/1DBSe2g Diabetes Care, online October 14, 2014.

  • Ibuprofen good as morphine, and safer, for kids with fractures

    By Kathryn Doyle

    (Reuters Health) - The narcotic drug morphine is not the best choice for pain relief in kids with broken bones, a new study suggests.

    Kids in the study took either morphine or ibuprofen by mouth. The morphine was associated with side effects like drowsiness, nausea and vomiting - but it wasn't any better than ibuprofen at relieving pain.

    "Both ibuprofen and oral morphine provided pain relief but there were no significant differences between the two agents," said lead author Dr. Naveen Poonai, a pediatric emergency physician at the London Health Sciences Centre in Ontario.

    "In our study, we found that drowsiness and nausea were the most common side effects but patients also reported dizziness and vomiting," Poonai told Reuters Health by email.

    The study involved 134 children between ages five and 17 who arrived at the emergency department with a broken bone of the arm or leg that didn't require surgery.

    Half of the kids were randomly assigned to receive oral morphine, dosed to 0.5 milligrams per kilogram of the child's weight, while the others received 10 mg/kg of ibuprofen, every six hours as needed for 24 hours after hospital discharge with a cast or sling. The medicines were not marked or labeled so the children and the parents did not know which painkiller they had received.

    Doctors told parents to use acetaminophen if needed for breakthrough pain.

    Patients received self-report pain measurement forms and were instructed to rate their pain on a scale of zero to five immediately before and 30 minutes after a painkiller dose.

    Both morphine and ibuprofen lowered pain scores by an average of 1 to 1.5 points from before administration to 30 minutes after a dose, according to results in the Canadian Medical Association Journal.

    The two groups did not differ in their overall pain reduction or in the use of acetaminophen for breakthrough pain.

    More than half of the morphine group reported a side effect of the medicine, most often drowsiness, compared to 31 percent of the ibuprofen group.

    In the morphine group, 18 patients reported nausea, compared to four in the ibuprofen group.

    Ibuprofen is a safe and effective choice for managing bone fracture pain for kids, the authors write.

    "Ibuprofen is the safer choice for the simple reason that we have a lot more experience with it in children and both health care workers and parents know what to expect when it is given," Poonai said.

    "There is very little pediatric acute pain research done in the 'at-home' setting where these analgesics are actually used," said Amy L. Drendel, an associate professor of Pediatric Emergency Medicine at the Medical College of Wisconsin in Milwaukee. "This provides real-life data about how these medications work in the outpatient setting."

    Drendel was not involved in the new study.

    "Many variables go into the decisions doctors make about pain management for children," she told Reuters Health by email. "I always recommend that parents talk with their doctor about their child's treatment to make sure their child receives the best care possible."

    Although it is understandably a big fear for doctors and parents, there is no evidence that children are at risk of opioid dependence to the same degree as adults, Poonai said.

    "Pain in the ER before a fracture is immobilized with a cast or splint is likely more severe than pain at home," he said. "But in our study we found that over 70 percent of children had pain severe enough to require pain medication after discharge."

    "This tells us that nurses and doctors should be teaching parents to recognize and manage pain at home and likely offering a dose of ibuprofen at discharge," he said.

    SOURCE: http://bit.ly/1xxCsBt Canadian Medical Association Journal, online October 27, 2014.

Transplant Articles

There are currently no articles to display.

Women’s Health Articles

  • Oregon, Alaska, D.C. voters to weigh legal marijuana in November

    By Andy Sullivan

    WASHINGTON (Reuters) - Voters in the U.S. capital and two West Coast states will decide in the Nov. 4 elections whether to legalize marijuana, pushing closer to the mainstream a notion that was once consigned to the political fringe.

    Ballot initiatives in Oregon and Alaska would set up a network of regulated pot stores, similar to those already operating in Colorado and Washington state. A measure in the District of Columbia would allow possession but not retail sales.

    If successful, the ballot initiatives could build momentum for legalization in other states and force candidates in the 2016 presidential election to take a stand on the issue.

    Public opinion on marijuana has shifted sharply in the past several years, and polls indicate more Americans now support legalization than oppose it. Advocates say that, like gay marriage, legal pot is an idea that gains support once people see it in action.

    "The more public dialogue that goes on about this issue, the more support there is," said Mason Tvert of the Marijuana Policy Project, which is supporting the legalization drive in Alaska.

    Opponents say legalization will create an aggressive new industry that, like the tobacco business, will profit by marketing an addictive product to teens. Unlike gay marriage, legal pot will have harmful effects, many say.

    "I don't know anybody who looks around and says, 'My life is better when everybody around me is stoned,'" said Kevin Sabet, a former White House drug-policy adviser who now heads up Smart Approaches to Marijuana, an anti-legalization group.

    Few elected officials in the country support legalization and observers do not expect that to change any time soon.

    "It seems that this is an area where the public is out in front of their elected officials," said Jake Weigler, an Oregon Democratic strategist not affiliated with the legalization effort.

    So for the moment advocates are focused on ballot initiatives. Such referendums allow voters to shape policy directly at the state level: this year alone, ballots in various states include measures to raise the minimum wage, restrict abortion and ban certain types of bear hunting.

    On the marijuana issue, voters in the District of Columbia back legalization by a two-to-one margin, according to recent polling, while a narrow majority supports legal pot in Oregon. Opinion polls in Alaska have been inconsistent.

    Nationwide, roughly one in four Americans say they have used pot, according to Reuters/Ipsos polling. Some 47 percent support legalization and 35 percent oppose it.

    Marijuana remains illegal under federal law, but President Barack Obama has allowed Colorado and Washington to move forward with legalization. Federal prosecutors have been told to focus enforcement on areas such as interstate trafficking and selling to minors, rather than possession. The next president will have to decide whether to continue that approach or to insist that federal law trumps local concerns.

    CHANGES OVER TWO DECADES

    Marijuana has been edging toward legal status across the country since California became the first state to allow its use for medical purposes in 1996.

    The medical use of marijuana, to ease ailments ranging from glaucoma to chronic pain, is now legal in 23 states and the District of Columbia. Florida may become the first state in the South to approve medical pot in November.

    Some 18 states have also removed criminal penalties for possession of small amounts, as policymakers on the left and the right have questioned the social and fiscal costs of imprisoning nonviolent drug users. Nationwide, about 650,000 people were arrested for marijuana possession in 2012, FBI statistics show.

    Colorado and Washington opened the first state-licensed pot stores earlier this year, following legalization referendums in 2012.

    Beau Kilmer, a drug policy expert at the RAND Corporation, a nonpartisan think tank, said it is too soon to determine how those efforts are faring because there is not enough data to determine whether legalization has led to more crime, higher rates of underage use, or more people driving while high.

    Colorado residents are split on legalization's merits. Some 51 percent of likely voters in the state support it and 41 percent oppose it, according to Reuters/Ipsos polling.

    Opponents of legal marijuana are not like the anti-drug warriors of past decades. Many support decriminalization and medical use, if done carefully, but argue that other states should not be in such a hurry to follow Colorado and Washington all the way to legal pot shops.

    "I don't want to speak for the next couple of years, but right now it's not the right choice," said Charles Fedullo, a spokesman for Big Marijuana Big Mistake, which opposes the legalization drive in Alaska.

    Advocates have plenty of money to spend. In liberal-leaning Oregon, backers are spending $2 million on a prime-time TV ad campaign. Opponents, meanwhile, have raised a mere $168,000, largely from law-enforcement groups. In Alaska, a Republican-leaning state with a strong libertarian streak, backers have raised $867,000 while opponents have raised $97,000.

    "This is a real David versus Goliath operation. We're the David," said Josh Marquis, an Oregon district attorney involved in the anti-legalization campaign.

  • Advanced ovarian cancer may someday be detected with tampons

    By Kathryn Doyle

    (Reuters Health) - In a small new study, ovarian cancer cells were detectable on the tampons of some women with advanced stage cancer.

    "This is a proof of principle study that certainly needs more work on it before we know how useful it will be," said Dr. Charles N. Landen Jr. of the University of Virginia, Department of Obstetrics and Gynecology.

    But it is helpful to know that you can pick up tumor DNA in vaginal secretions, Landen told Reuters Health by phone.

    Ovarian cancer is often diagnosed at a late stage, since there is no effective screening method for early-stage ovarian cancer. About 22,000 women are diagnosed with ovarian cancer in the U.S. each year, and almost 14,300 will die, according to the American Cancer Society.

    Landen and his coauthors studied eight women with advanced serous ovarian cancer, which is the most common form of ovarian cancer. Eight to 12 hours before surgery, they each inserted a commercially available tampon, which was removed in the operating room.

    All eight women had TP53 DNA mutations in their tumors, which is a very common mutation for this form of cancer, the authors write.

    Five of the women had intact fallopian tubes, while three had had tubal ligation surgery previously.

    Of the five women who did not have their "tubes tied," three had the exact same TP53 mutations detectable from their tampon samples, according to results published in the journal Obstetrics & Gynecology.

    Identifying three out of five, or 60 percent, of cancers is not bad, but not ideal for a disease as rare as ovarian cancer, Landen said.

    "It's not enough for us to have total confidence over its ultimate utility," he said.

    None of the women with tubal ligation had tumor mutations in their tampon samples.

    "We have no way of knowing whether or not the DNA we picked up originated in the fallopian tubes or in the abdominal cavity," but either way it does demonstrate that cancer happening elsewhere in the genital tract does affect the vaginal canal, Landen said.

    A previous study found similar tumor DNA detectable by Pap smear.

    This is not yet a breakthrough in detecting ovarian cancer, according to Paul Spellman, who researches the biology of cancer at Oregon Health & Science University in Portland, and was not involved in the study.

    "These findings are helping researchers move toward a method for screening for ovarian cancer," said Dr. Shannon N. Westin of the Department of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center in Houston. "This has certainly been a 'holy grail' for some time."

    Westin was not involved in the new study.

    "Thus far, imaging and serum tests have not been able to reliably detect ovarian cancer at an early stage," she told Reuters Health by email. "Ovarian cancer survival is significantly improved when detected at an early stage."

    Five years after diagnosis with stage 1 ovarian cancer, approximately 90 percent of women have survived, compared to approximately 35 percent for Stage IIIc, the most commonly diagnosed stage, she said.

    It is not clear if this kind of tampon screening would identify early-stage cancers of the ovaries or fallopian tubes, Landen said.

    This pilot study did identify some advanced cancers, and may be more useful some day as targeted screening for women at high risk, like those with a family history of ovarian cancer or those with the BRCA mutations, especially younger women who still want to have children and don't want their ovaries removed unless absolutely necessary, he said.

    Though this method of detection is a long way from actually being used to screen women for early stage ovarian cancer, it does have the advantage that it's relatively easy for women to do and doesn't involve surgery, he noted.

    SOURCE: http://bit.ly/ZTNTse Obstetrics & Gynecology, November 2014.

  • Stroke patients miss cholesterol-lowering targets

    By Ronnie Cohen

    NEW YORK (Reuters Health) - More than half of patients with a recurrent stroke or other cerebrovascular attack failed to meet recommended targets for so-called bad cholesterol levels, a new study showed.

    The research examined more than 900,000 patients admitted to U.S. hospitals from 2003 to 2012 after suffering a stroke or transient ischemic attack (a brief episode of brain dysfunction, also called a TIA).

    Of nearly 195,000 who'd already had a stroke or TIA in the past, more than 106,000 had high levels of low-density lipoprotein (LDL) cholesterol in their blood. (During the study period, experts were advising that LDL levels be kept below 100 milligrams per deciliter.)

    Only 62 percent of the patients admitted for stroke or TIA who already had coronary artery disease met the recommended LDL targets. And only 52 percent of those with diabetes met the targets, the researchers reported in the journal Stroke.

    The American Heart Association explains (here: http://bit.ly/1tS3rX0) that when there's too much LDL cholesterol in the blood, it can build up in the arteries that feed the heart and brain, helping to form a thick, hard plaque that prevents enough blood from getting through. If the artery is completely blocked, a heart attack or stroke can result.

    "We need better mechanisms in place to emphasize the importance of cardiovascular and stroke prevention strategies to help our patients to decrease the risks of heart attacks and strokes," lead author Dr. Gustavo Saposnik told Reuters Health.

    He directs the Stroke Outcome Research Center at the University of Toronto's St. Michael's Hospital.

    All the patients should have been on cholesterol-lowering medications and should have been counseled on diet and exercise, Saposnik said.

    Women were even less likely to meet goals for cholesterol than men, the study found.

    "I think our study reveals that there is a good opportunity for improving stroke and cardiovascular prevention," Saposnik said. "This is an opportunity."

    The challenge, however, is determining why patients failed to meet the goals for reducing harmful cholesterol levels.

    Saposnik suggested four factors that could be at play. Doctors might not have prescribed the recommended lipid-lowering medications; patients might not have taken the medicine; patients may not have been able to afford the medicine; or patients who were taking the medicine may have had such high LDL cholesterol that it remained above the recommended target.

    But in an editorial published with the study, Dr. Larry B. Goldstein from Duke University Medical Center in Durham, North Carolina notes the challenge in using the study to help patients in the future.

    "The implication is that better adherence to treatment targets would reduce the incidence of cerebrovascular events," the editorial says. "The interpretation of the data and consequences for current practice, however, are not entirely straightforward."

    Since 2003, when the study started, the guidelines have changed several times. The latest guidelines - which completely drop the idea of specific targets - have sparked fierce debate (see Reuters story of March 19, 2014 here: http://reut.rs/1tpQLZJ).

    Instead of working to lower a patient's "bad" LDL cholesterol to specific numeric targets, the 2013 recommendations from the American Heart Association and the American College of Cardiology ask doctors to use an online calculator to consider risk factors such as smoking and obesity.

    Patients with a 7.5 percent or greater chance of having heart disease within 10 years would be considered eligible for treatment with a statin.

    Critics say the risk calculator overestimates the number of people in need of treatment.

    One of the reasons the 2013 guidelines don't encourage using LDL cholesterol targets is because a committee investigating the question concluded there was no evidence that hitting a specific goal lowers heart attack or stroke risk.

    But some doctors are still convinced it does.

    Cardiologist Dr. David Frid is one of them. While he recognizes that there was never a randomized trial that took patients to the LDL cholesterol goal, he continues to treat his patients to the target, he told Reuters Health.

    Frid is from the Cleveland Clinic in Ohio and was not involved in the current study.

    "It's been shown that statin medications significantly reduce risk in conjunction with diet and exercise," he said.

    "What the researchers found was unfortunately the majority of patients were not treated as aggressively as they should be," he said.

    Part of the problem, in Frid's view could stem, from the fact that neurologists, who take care of stroke patients, might not be as keen to prescribe cholesterol-lowering drugs as cardiologists.

    "This article tells me we're not doing as good a job as we should be," he said.

    SOURCE: http://bit.ly/ZykkvN and http://bit.ly/1CRXeNO Stroke, online October 9, 2014.

  • CORRECTED-Oklahoma judge allows law banning abortion pills to take effect

    (Corrects name of group in third paragraph to Oklahoma Coalition for Reproductive Justice, not Oklahoma Coalition for Reproductive Services)

    By Heide Brandes

    OKLAHOMA CITY (Reuters) - An Oklahoma judge said on Wednesday he will allow a law that bans abortion-inducing drugs to take effect as planned on Nov. 1, over the objections of abortion rights advocates who said the measure is poor public health policy that could put women at risk.

    Oklahoma District Court Judge Robert Stuart turned down a request by abortion rights groups to halt the measure from taking effect. Stuart also allowed a provision that would limit liability claims against physicians due to the law.

    According to the lawsuit filed on behalf of Reproductive Services in Tulsa and the Oklahoma Coalition for Reproductive Justice this month, the measure would lead to increased use of surgically induced abortions for cases where drugs can be used.

    "This law is contrary to protecting women's health and will force doctors to use an outdated and less safe medical procedure," said Autumn Katz, staff attorney for the Center for Reproductive Rights.

    The defendants said the use of the drugs could cause harm to pregnant women because they can be used for procedures not approved by the U.S. Food and Drug Administration.

    Earlier this year, lawmakers in the heavily Republican state approved new restrictions on abortion clinics they said were aimed at protecting women's health, but abortion rights advocates said were actually intended to shut clinics.